International Journal of Trichology International Journal of Trichology
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Year : 2013  |  Volume : 5  |  Issue : 4  |  Page : 217-219

Frontal fibrosing alopecia and lupus overlap in a man: Guilt by association?

1 Department of Dermatopathology; St. John's Institute of Dermatology, St. Thomas' Hospital, London, United Kingdom
2 St. John's Institute of Dermatology, St. Thomas' Hospital, London, United Kingdom

Correspondence Address:
Catherine M Stefanato
Department of Dermatopathology, St. John's Institute of Dermatology, St. Thomas' Hospital, Westminster Bridge Road, SE1 7EH, London
United Kingdom
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0974-7753.130420

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Frontal fibrosing alopecia (FFA) is a scarring alopecia, now an accepted subset variant of lichen planopilaris (LPP). Its occurrence in males is rare, with only nine cases reported to date. We describe a case of FFA in a male in association with lupus erythematosus. Multiple biopsies from the scalp, eyebrow and arm showed features consistent with LPP, in keeping with the clinical presentation of FFA. Direct immunofluorescence studies showed a positive lupus band test. Further serological investigation confirmed the presence of antinuclear, anticardiolipin and lupus anticoagulant antibodies. Whilst the findings of lupus erythematosus may be coincidental or a forme fruste of the disease occurring in association with FFA, it is feasible that lupus and LPP may occur as an overlap syndrome. This case underscores the importance of multiple biopsies and the role of direct immunofluorescence in disclosing more than one pathology in the follow-up of patients with scarring alopecia.

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