Differentiation of Frontal Fibrosing Alopecia and Lichen Planopilaris on Trichoscopy: A Comprehensive Review

October 2021 in “ Journal of Cosmetic Dermatology ”

A. Rajan, Lidia Rudnicka, Jacek Szepietowski, Aimilios Lallas, Ghasem Rahmatpour Rokni, Stephan Grabbe, Mohamad Goldust

frontal fibrosing alopecia lichen planopilaris trichoscopy primary lymphocytic cicatricial alopecia autoimmune process postmenopausal hormonal factors apoptosis perifollicular collar-like scaling catagen-telogen type terminal hair FFA LPP

TLDR Trichoscopy helps tell apart Frontal Fibrosing Alopecia and Lichen planopilaris by showing different hair and scalp features.

The review discusses the use of trichoscopy in differentiating between Frontal Fibrosing Alopecia (FFA) and Lichen planopilaris (LPP), two types of primary lymphocytic cicatricial alopecia. These conditions can mimic other hair loss conditions, making diagnosis challenging. LPP's etiology may involve an autoimmune process triggered by various factors, while FFA commonly occurs in postmenopausal women, with hormonal and autoimmune factors involved. Both conditions can co-exist in the same patient. Histopathology shows similarities between LPP and FFA, but FFA has less inflammation and more apoptosis. Trichoscopy can aid in differential diagnosis, with LPP showing perifollicular collar-like scaling and FFA showing more catagen-telogen type terminal hair. The review also introduces the concept of "invisible LPP", where trichoscopy can indicate LPP before visible hair loss occurs.

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