Nail Involvement in Frontal Fibrosing Alopecia

In 2015, a case of frontal fibrosing alopecia (FFA) with nail involvement was reported, providing evidence for underlying lichen planus and suggesting that FFA is a more generalized than localized process. The 60-year-old female patient presented with a history of asymptomatic progressive recession of the frontal hairline and loss of eyebrows. Clinical examination revealed a marginal alopecia along the fronto-temporal hairline and loss of eyebrows. The nail plate of the right fifth digit demonstrated ridging, fissuring, and superficial fragility, indicative of lichen planus. The patient was treated with 0.5 mg oral dutasteride and 0.05% topical clobetasole propionate, showing a reduction of signs of follicular inflammation by dermoscopic examination at 3 months follow-up. This case suggests that FFA may be a variant of lichen planus, a T-cell mediated autoimmune reaction, and that oral dutasteride may be beneficial in cases where androgenetic alopecia is a co-morbid condition.