Discoid Lupus Alopecia Complicated by Frontal Fibrosing Alopecia on a Background of Androgenetic Alopecia

This document reports a case of a 69-year-old woman with discoid lupus alopecia (DLE) and frontal fibrosing alopecia (FFA) on a background of androgenetic alopecia (AGA). The patient had lesions on the scalp, face, neck, and chest demonstrating a typical, atrophic appearance. Histopathology from a lupus lesion on the scalp showed a lichenoid inflammatory reaction with cell death and vacuolar change involving the hair follicles, typical of DLE. The frontal scalp showed a prominent superficial and deep perifollicular lymphocytic inflammatory infiltrate with extensive dermal fibrosis and a reduction in terminal hairs with increased vellus hairs, typical of FFA. The document also discusses the keratin expression in medullated human scalp hairs and the androgenic regulation of in vitro hair keratin K37 expression.