St. John's Institute of Dermatology, St. Thomas' Hospital, London, UK.
J Am Acad Dermatol. 2010 Oct;63(4):653-60. doi: 10.1016/j.jaad.2009.09.020.
In frontal fibrosing alopecia (FFA), scalp alopecia dominates the clinical picture. However, eyebrow loss and hair loss in other body sites may also occur; this has been documented clinically, but rarely histopathologically. We describe the clinicopathological findings of 13 cases of FFA, with histopathologic data from the scalp, eyebrow, and body hair.
Thirteen patients with a diagnosis of FFA, seen between 2006 and 2008, were included. Scalp biopsies were performed in all patients for histology and direct immunofluorescence (DIF). Biopsy specimens for histology were taken from the eyebrow in 6 patients and from the upper limb in 5 patients.
All 13 patients were female, 11 of whom were postmenopausal. The median age at onset of alopecia was 57 years. Clinical examination revealed a band of frontal hairline recession in all patients. Eyebrow loss was present clinically in all patients, with loss of body hair in 10 of 13. Histopathologic examination of the scalp, eyebrow, and upper limb skin biopsy specimens showed similar features, including a marked reduction in the number of hair follicles and a perifollicular lymphoid cell infiltrate with perifollicular fibrosis. Direct immunofluorescence was negative in all cases.
Not all patients consented to biopsies of the eyebrows or upper limbs.
Eyebrow and peripheral body hair loss is not uncommon in FFA-a finding that is likely underreported. We have demonstrated that alopecia of the upper limbs in FFA is indeed common and, histopathologically, shows features of lichen planopilaris and scarring, similar to findings in the scalp and eyebrows. Consequently, the process of lichen planopilaris with scarring alopecia is generalized rather than localized only to the frontal scalp and eyebrows.
在额部纤维性脱发（FFA）中，头皮脱发主导临床表现。然而，眉毛和其他身体部位的毛发缺失也可能发生；这在临床上已有记录，但很少有组织病理学记录。我们描述了 13 例 FFA 的临床病理发现，这些病例有头皮、眉毛和身体毛发的组织病理学数据。
纳入了 2006 年至 2008 年间诊断为 FFA 的 13 例患者。所有患者均进行了头皮活检，用于组织学和直接免疫荧光（DIF）检查。6 例患者进行了眉毛活检，5 例患者进行了上肢活检。
所有 13 例患者均为女性，其中 11 例处于绝经后状态。脱发的中位发病年龄为 57 岁。所有患者的临床检查均显示额部发际线退缩。所有患者均有临床可见的眉毛缺失，13 例中有 10 例有身体毛发缺失。头皮、眉毛和上肢皮肤活检的组织病理学检查显示出相似的特征，包括毛囊数量明显减少和毛囊周围淋巴细胞浸润伴毛囊周围纤维化。所有病例的直接免疫荧光均为阴性。
并非所有患者都同意进行眉毛或上肢活检。
FFA 并不罕见会出现眉毛和外周身体毛发缺失，这一发现可能报告不足。我们已经证明，FFA 中的上肢脱发确实很常见，在组织病理学上，其表现为扁平苔藓样瘢痕性脱发的特征，与头皮和眉毛的表现相似。因此，瘢痕性脱发的扁平苔藓样过程是全身性的，而不仅仅局限于额部头皮和眉毛。
