Disseminated Small Papules on the Face: A Quiz

    January 2019 in “ Acta dermato-venereologica ”
    Victor Olsavszky, Cyrill Géraud, Moritz Felcht
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    TLDR The woman's skin and hair symptoms were confirmed as frontal fibrosing alopecia, and while facial papules are common in such cases, there's no effective local treatment, but systemic treatments can help.
    The document discusses a case of a woman in her 40s with progressive facial skin lesions and hair loss, diagnosed with frontal fibrosing alopecia (FFA) presenting with keratosis pilaris-like papules. Biopsies revealed follicular dilatation with comedo-like hyperkeratosis and follicular interface dermatitis, confirming FFA. The patient had positive antinuclear and anti-centromere antibodies but no Raynaud symptoms or sclerodactyly. Treatment included clobetasol solution and hydroxychloroquine, with a 3-month follow-up. FFA, first described in 1994, is often associated with perifollicular erythema and hyperkeratosis, and eyebrow hair loss. Facial papules in FFA, which occur in 14-21% of cases, are often unrecognized by clinicians. There is no known effective local therapy for these papules, but systemic treatments like corticosteroids, antimalarials, and isotretinoin have shown improvements. The document emphasizes the importance of recognizing the association between keratosis pilaris-like papules and FFA for accurate diagnosis and treatment.
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