Doche Isabella, Rebeis Marina, Valente Neusa, Rivitti-Machado Maria Cecília
Department of Dermatology, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil.
Skin Appendage Disord. 2021 Jan;7(1):71-74. doi: 10.1159/000512034. Epub 2020 Dec 17.
Lichen planopilaris (LPP) is a primary lymphocytic cicatricial alopecia with 3 recognized clinical variants. Lately, LPP clinical spectrum has expanded with new and overlapping clinical variants. First considered as a subtype of LPP affecting postmenopausal women, the increasing worldwide incidence of FFA including atypical lesions in young female and male suggests a different pathomechanism for this disease. Although LPP-spectrum disorders may share similar histopathological findings, clinical features and prognosis are different.
A 26-year-old Caucasian male presented with occipital scarring alopecia and pruritus for the last 6 months. The patient had been treated for an associated androgenetic alopecia and superficial recurrent scalp folliculitis over the vertex scalp for the last 5 years. Trichoscopy of the occipital scalp showed mild diffuse erythema, moderate peripilar scaling, and absence of follicular openings, suggestive of a scarring process. The patient underwent an occipital scalp biopsy that confirmed the diagnosis of a LPP-spectrum disorder.
DISCUSSION/CONCLUSION: Both LPP and FFA mostly affect the anterior-mid scalp of females. However, recent reports on FFA also in premenopausal women and men should make physicians aware of atypical features of this disease and unusual clinical presentation.
扁平苔藓样毛发角化病（LPP）是一种原发性淋巴细胞性瘢痕性脱发，有3种公认的临床变体。近来，LPP的临床谱随着新的和重叠的临床变体而扩大。FFA最初被认为是LPP的一种亚型，影响绝经后女性，但全球范围内FFA发病率上升，包括年轻女性和男性中的非典型病变，提示该病有不同的发病机制。尽管LPP谱系疾病可能有相似的组织病理学表现，但临床特征和预后不同。
一名26岁的白种男性在过去6个月出现枕部瘢痕性脱发和瘙痒。该患者在过去5年中一直在治疗头顶头皮的雄激素性脱发和浅表复发性头皮毛囊炎。枕部头皮的毛发镜检查显示轻度弥漫性红斑、中度毛囊周围脱屑，且无毛囊开口，提示有瘢痕形成过程。患者接受了枕部头皮活检，确诊为LPP谱系疾病。
讨论/结论：LPP和FFA大多影响女性的前中头皮。然而，最近关于绝经前女性和男性中FFA的报道应使医生意识到该病的非典型特征和不寻常的临床表现。
