Case Number : Case 1711 - 19 December - Dr Limin Yu Posted By: Guest

Start your week off with this interesting Spot Diagnosis case from Dr Limin Yu.

Cheers, Geoff Cross - DermpathPRO Projects

Perifollicular concentric fibrosis with persistent lymphocytic infiltrate that backs away, unaffected sweet glands, dermal scar, cleft between follicular and stroma, fit well LPP, late stage...

Lichen Planus Pilaris

Cicatricial alopecia with follicular fusion, follicular drop out, concentric fibrosis and dense lichenoid infiltrate. At the interface between the dermis and the subcutis we can see diminished follicular elements with many fibrous tracts and absence of inflamation around eccrine units. So I believe this is LPP or Frontal fibrosing alopecia, it depends on the clinical context.

LPP vs FFA according to clinical correlation.

Lymphocytic scarring alopecia with perifollicular fibroplasia featuring concentric lamellar fibrosis that puts away the lymphocytic infiltrate from the follicle and also featuring mucinous fibrosis that makes a cleft between the follicular epithelium and the surround dermis. There’s no interfollicular dermal mucin nor widowed sebaceous gland. Lichen planopilaris or one of its clinical variants.

Agree with colleagues

Agree, lymphocytic scarring alopecia. DD: Lichen planus/FFA

Agree LPP or FFA

Agree with LPP or FFA . mucinous fibroplasia and artifactual cleft around hair follicle,perifollicular lymphocytic infiltration,polytrichia,focal follicular drop out along with scar formation and some fibrous tracts are quite suggestive .

Agree with profound respect!  This histologic ddx includes and  LPP vs FFA.  Clinically it fit LPP!