Case Number : Case 1812 - 09 May - Dr Uma Sundram Posted By: Guest

Today you have your very own 1812 Overture with a great case from Dr Uma Sundram.

Geoff Cross - DermpathPRO Projects

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Alopecia isn't my strong suit. But I want be sporty and try the same: thinking of a scarring alopecia, with lichenoid lymphocytic coat and concentric lamellar perifollicular fibrosis...LPP?

Scarring alopecia. Perifolicular fibrosis. Lichenoid lymphocitic infiltrate  is limited to isthmic region of follicle. I'd think lichen planopilaris. I'd like to look vertical section  to see interfollicular epitelia 

LPP or frontal fibrosing alopecia depending on the clinical details of the type of hair loss

Lymphocytic scarring alopecia with vacuolar interface change at the level of the isthmus (infundibulum, not shown, is also likely to be affected) in some follicles and concentric lamellar perifollicular fibroplasia that backs away the lichenoid infiltrate from other follicles. Interfollicular dermal mucin is absent. Lichen planopilaris is my opinion, but appreciating the clinical history of a postmenopausal women, the variant frontal fibrosing alopecia is favored.

Agree

Agree LPP

Agree FFA/LPP

We don't get to see a lot of alopecia in practice (unless you're Dr Stefanato!) so I thought i would include a relatively straightforward example of LPP/FFA. DDX is lupus which was excluded based on lack of deep periadnexal infiltrate. CCSA is also a reasonable thing to think of but no premature desquamation is seen. There are a lot of fibrous stele in this case and noticeable number of telogen phase follicles.

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