Understanding Fibrosing Alopecia in a Pattern Distribution: A Retrospective Study with Histological Challenges in the Diagnosis of Diffuse Central Alopecia

    February 2025 in “ Archives of Dermatological Research
    Betina Werner, Vanessa Cristina Soares, Fabiane Mulinari‐Brenner, Stanislav N. Tolkachjov
    TLDR Fibrosing alopecia can be diagnosed without typical signs of lichen planopilaris.
    This study on fibrosing alopecia in a pattern distribution (FAPD) analyzed 35 scalp biopsies from 22 patients, focusing on 28 histopathologic criteria. Key findings included cicatricial fibrous tract (CFT) and lichenoid inflammation, with 45% of samples showing a low terminal to vellus hair ratio and 55% exhibiting lichenoid inflammation. The study suggests that FAPD can be diagnosed in the absence of lichen planopilaris (LPP) signs or when perifollicular fibrosis and a higher terminal to vellus hair ratio complicate an androgenetic alopecia (AGA) diagnosis. CFT and lichenoid inflammation may indicate potential LPP with a diffuse initial presentation and possible scarring.
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