Fibrosing Alopecia in a Pattern Distribution

January 2020 in “ Journal of The American Academy of Dermatology ”

Jacob Griggs, Ralph M. Trüeb, Maria Fernanda Reis Gavazzoni Dias, Maria Hordinsky, Antonella Tosti

fibrosing alopecia pattern distribution scarring alopecia androgenetic alopecia lichen planopilaris patterned hair thinning inflammation follicle miniaturization seborrheic dermatitis trichoscopy biopsy anti-inflammatory agents hair growth-promoting agents topical corticosteroids minoxidil oral hydroxychloroquine AGA LPP Rogaine

Studysummary This review reports no new clinical results but discusses fibrosing alopecia in a pattern distribution as a distinct scarring alopecia with characteristics of both androgenetic alopecia and lichen planopilaris.

Our plain-language summary. Not medical advice or a treatment recommendation. Consult a qualified healthcare professional before changing treatment. Full disclaimer

Fibrosing alopecia in a pattern distribution (FAPD) is a scarring alopecia that exhibits features of both androgenetic alopecia (AGA) and lichen planopilaris (LPP), affecting 188 patients (164 female, 24 male, average age 53.8) according to 15 articles reviewed. It is characterized by patterned hair thinning, inflammation, and follicle miniaturization, and is often misdiagnosed as AGA with seborrheic dermatitis. Diagnosis involves physical examination, trichoscopy, and a biopsy. Treatment options are limited and focus on anti-inflammatory and hair growth-promoting agents, with some success reported using topical corticosteroids, minoxidil, and oral hydroxychloroquine. Early recognition and treatment are crucial, but significant hair regrowth is not typically expected in advanced cases. Further research is needed to establish specific treatment guidelines.

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Research cited in this study

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research Frontal Fibrosing Alopecia: An Update on Pathogenesis, Diagnosis, and Treatment

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research Off-Label Use of Topical Minoxidil in Alopecia: A Review

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This review discusses the use of topical minoxidil for various types of alopecia and reports mixed evidence on its efficacy, with stronger support noted for conditions like eyebrow hypotrichosis and chemotherapy-induced alopecia.

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56 citations , January 2019 in “Skin appendage disorders”

In this multicenter study, androgenetic alopecia was the most common type of alopecia among both men and women attending specialty hair clinics on four continents.

research Fibrosing Alopecia in a Pattern Distribution in 16 African-Descent and Hispanic Female Patients: A Challenging Diagnosis

13 citations , January 2019 in “Skin appendage disorders”

This study reported that fibrosing alopecia in a pattern distribution can occur in patients of color, with clinical and histopathological features allowing for an accurate differential diagnosis.

research White And Yellow Dots As New Trichoscopic Signs Of Severe Female Androgenetic Alopecia In Dark Skin Phototypes

9 citations , July 2018 in “International Journal of Dermatology”

This study suggests that yellow and white dot signs may be new dermoscopic indicators of advanced androgenetic alopecia in dark-skinned females, with certain trichoscopic features associated with darker skin types.

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13 citations , January 2018 in “International Journal of Dermatology”

This clinical study on fibrosing alopecia in a pattern distribution among a Latin American population reports no new results but addresses this specific condition in its demographic context.

Graft Versus Host Disease Presenting as Fibrosing Alopecia in a Pattern Distribution: A Model for Pathophysiological Understanding of Cicatricial Pattern Hair Loss

research Graft Versus Host Disease Presenting as Fibrosing Alopecia in a Pattern Distribution: A Model for Pathophysiological Understanding of Cicatricial Pattern Hair Loss

9 citations , January 2018 in “International Journal of Trichology”

This case report discusses cutaneous graft versus host disease presenting as fibrosing alopecia, suggesting a mechanistic model for understanding cicatricial pattern hair loss.

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5 citations , November 2017 in “Dermatologica Sinica”

In this study, transverse sectioning of scalp biopsy samples showed higher diagnostic accuracy than vertical sectioning for noncicatricial alopecia, although both techniques are important for accurate diagnosis.

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8 citations , August 2017 in “Skin appendage disorders”

Red dots on the upper chest may be an early sign of certain types of hair loss.

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65 citations , November 2016 in “Journal of The American Academy of Dermatology”

This article reviews various types of primary cicatricial alopecias and emphasizes the importance of accurate diagnosis to improve management strategies, particularly detailing remaining lymphocytic forms and expanding on neutrophilic and mixed types.

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9 citations , September 2016 in “Dermatologic Surgery”

This study identified a new subtype of lichen planopilaris that mimics androgenetic alopecia, selectively affecting vellus hair follicles and presenting unique histopathological features.

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110 citations , August 2016 in “Drugs”

Minoxidil is the only FDA-approved topical drug for treating male or female pattern hair loss, and other medications like finasteride and dutasteride can also increase hair growth.

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64 citations , June 2014 in “Journal of The American Academy of Dermatology”

This study found that a peripilar white gray halo around hair emergence is a highly specific and sensitive dermatoscopic feature for diagnosing central centrifugal cicatricial alopecia in African American patients with mild central thinning.

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245 citations , March 2012 in “Journal of The American Academy of Dermatology”

This review discusses the dermoscopic features of common hair and scalp disorders and reports no new clinical results, aiming to assist dermatologists in diagnosing conditions like tinea capitis and alopecia areata.

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This article reviews the potential relationship between different forms of permanent hair loss such as cicatricial pattern hair loss and discusses related conditions, reporting no new clinical findings.

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9 citations , November 2004 in “SKINmed Dermatology for the Clinician”

This case report describes a 54-year-old man diagnosed with fibrosing alopecia in a pattern distribution, presenting with follicular inflammatory lesions and scleroatrophy on the scalp.

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158 citations , February 2000 in “Archives of dermatology”

This study reports that some patients with androgenetic alopecia may also exhibit clinical and histological features of inflammation and fibrosis, similar to those found in lichen planopilaris.

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This review explores the psychological and medical implications of hair loss, suggesting it may indicate a serious systemic disorder, but it does not present new research findings.

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The authors concluded that chronic telogen effluvium in middle-aged women presents distinct clinical and histological features that differ from androgenetic alopecia and acute telogen effluvium.

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This study concluded that horizontal sections of scalp biopsy specimens provide more diagnostic information for male pattern androgenetic alopecia than vertical sections and can predict hair regrowth potential following topical minoxidil therapy.

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In this study, researchers identified a form of irreversible scalp alopecia in Black women using hot combs, characterized by incomplete hair loss primarily on the crown and follicular scarring.