Sarcoidosis Presenting as Frontal Fibrosing Alopecia: A Master Mimicker or a Coincidental Finding?

February 2017 in “ The American journal of dermatopathology/American journal of dermatopathology ”

Geraldine Cheyana Ranasinghe, Sara Hogan, Omer Ibrahim, Melissa Piliang

frontal fibrosing alopecia granulomatous dermatitis sarcoidosis Kenalog tetracycline hydroxychloroquine ketoconazole shampoo angiotensin-converting enzyme FFA Plaquenil Nizoral

TLDR Sarcoidosis can mimic other skin disorders, making diagnosis challenging.

A 73-year-old woman presented with pruritic scalp nodules and plaques, hairline regression, and eyebrow alopecia. Biopsies revealed granulomatous dermatitis consistent with sarcoidosis and frontal fibrosing alopecia (FFA). Elevated angiotensin-converting enzyme levels and normal pulmonary tests supported systemic sarcoidosis diagnosis. Treatment included Kenalog injections, tetracycline, hydroxychloroquine, and ketoconazole shampoo, leading to partial lesion resolution and symptom improvement. This case highlighted the diagnostic challenge of sarcoidosis mimicking other cutaneous disorders and emphasized the importance of scalp biopsy in patients with severe pruritus and hair loss.

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