Fibrosing Alopecia in a Pattern Distribution

In the document, Fibrosing alopecia in a pattern distribution (FAPD) is described as a distinct type of cicatricial alopecia that presents with symptoms similar to male or female pattern hair loss but includes inflammation and fibrosis. A case of a 27-year-old man with a 5-year history of progressive hair loss and mild pruritus is discussed. His physical examination showed decreased follicular density, absence of follicular orifices, and erythematous scaly lesions with a violaceous hue. Histopathological examination revealed miniaturized hair follicles, perifollicular lamellar fibrosis, and lymphocytic infiltration, without detection of antibodies. The condition shares features with both androgenetic alopecia (AGA) and lichen planopilaris (LPP), and preliminary observations suggest that antiandrogen therapy may stabilize hair loss progression and decrease scalp inflammation in FAPD, indicating a potential role for androgens in its pathogenesis. However, further studies are needed to confirm these findings. The document also compares FAPD with other conditions such as frontal fibrosing alopecia, follicular degeneration syndrome, and pseudopelade of Brocq, highlighting the unique characteristics of FAPD.