BH03: Systemic Sclerosis and Frontal Fibrosing Alopecia: A Novel Combination of Scarring Alopecia

A 43-year-old female patient with systemic sclerosis for 10 years developed a unique type of scarring alopecia that extended from the frontotemporal to the occipital area of her scalp. Histopathological examination of scalp biopsies revealed changes consistent with both systemic sclerosis and frontal fibrosing alopecia (FFA), including thickened dermal collagen, lymphoid cell infiltration around hair follicles, mild fibrosis, and hair follicle miniaturization. Blood tests confirmed systemic sclerosis with elevated erythrocyte sedimentation rate and positive antibodies. The authors suggest that FFA may be related to systemic sclerosis through a process called epitope spreading, where increased levels of certain tissue inhibitors and enzymes could cause keratinocyte apoptosis seen in FFA. This case represents the first reported instance of scarring alopecia with features of both systemic sclerosis and FFA.