Acquired Hyperpigmentation and Cicatricial Alopecia

The document discusses a case of a 69-year-old Hispanic postmenopausal woman who presented with acquired hyperpigmentation and cicatricial alopecia, specifically lichen planus pigmentosus (LPP) and frontal fibrosing alopecia (FFA). LPP is characterized by grey to brown macules, particularly in sun-exposed areas, and FFA is a scarring alopecia affecting the frontal hairline and eyebrows, mainly in postmenopausal women. The patient's skin and scalp biopsies were consistent with LPP and FFA, respectively. She was treated with chloroquine, topical tacrolimus, and sunscreen, resulting in mild improvement. The document highlights the importance of examining patients with acquired hyperpigmentation for signs of FFA to initiate early treatment and prevent further alopecia. It also notes that more than 50% of patients with FFA have LPP, and LPP usually precedes FFA by several months to years. There is no established treatment for FFA, but corticosteroids, hydroxychloroquine, and oral finasteride or dutasteride have been reported to be effective. The case emphasizes the need for awareness among physicians of the potential coexistence of LPP and FFA.