BH12: Frontal fibrosing alopecia affecting the glabella and lower forehead without scalp involvement

Orla McFeely, Liana Victory, Emily Pender and Aoibheann Flynn

Mater Misericordiae University Hospital, Dublin, Ireland

A 59-year-old white woman presented with a 7-year history of a rash affecting her glabellar area and lower forehead. She described an intermittent burning sensation and gradual progression of the rash to involve the lower half of her forehead. Her past medical history included hypertension and anxiety. Examination revealed perifollicular erythema scattered across her lower forehead, glabellar area and lateral eyebrows, with noticeable thinning of both eyebrows. There was no scale or perifollicular papules. Her frontal hairline was unaffected. Our differential included an atypical lichen planopilaris or an unusual ulerythema ophyrogenes. A punch biopsy was performed. Histological examination showed lichenoid perifollicular lymphocytic inflammation without follicular keratin plugs or fibrous tracts. The histological appearances were consistent with frontal fibrosing alopecia (FFA). Moderate potent topical steroids were prescribed daily for 4 weeks. Upon reviewing the patient’s abnormal liver function tests, the decision was taken not to initiate hydroxychloroquine. Lichen planopilaris (LPP) is a rare inflammatory lymphocytic cicatricial alopecia. FFA is a variant of LPP characterized by scarring alopecia of the frontotemporal hairline. There may be associated eyebrow involvement (MacDonald A, Clark C, Holmes S. Frontal fibrosing alopecia: a review of 60 cases. J Am Acad Dermatol 2012; 67: 955–61) and facial papules. Eyebrow involvement has been reported to precede scalp involvement by years; however, the length of prior eyebrow involvement has never been specified (Starace M, Brandi N, Alessandrini A et al. Frontal fibrosing alopecia: a case series of 65 patients seen in a single Italian centre. J Eur Acad Dermatol Venereol 2019; 33: 433–8). We note a case series published outlining three patients each with a short history of partial eyebrow loss secondary to FFA. Given our patient had activity for 7 years with clinical progression, symptomatic burning sensation and no involvement of the frontal hairline or scalp, we feel this case is worth highlighting as an unusual presentation of FFA.