Alopecia Areata Masquerading as Frontal Fibrosing Alopecia

Postmenopausal women with frontal hair recession posed a diagnostic challenge due to the clinical similarities between frontal fibrosing alopecia and alopecia areata. A 53-year-old postmenopausal woman exhibited progressive fronto-temporal marginal alopecia while her eyebrows remained unaffected. A scalp biopsy showed peribulbar lymphocytic inflammation without lichenoid inflammation, perifollicular fibrosis, or scarring, indicating alopecia areata. Despite the pathology suggesting alopecia areata, the clinical presentation resembled frontal fibrosing alopecia, highlighting the difficulty in distinguishing between these conditions. This case illustrated an atypical presentation of alopecia areata that could be mistaken for frontal fibrosing alopecia.