frontal fibrosing alopecia ( ffa ) is increasingly considered as a distinct variant of lichen planopilaris ( lpp ) , with scarring alopecia of frontotemporal hairline and nonscarring alopecia of the eyebrows . ffa and graham  little  piccardi syndrome ( glps ) can be considered as spectrum of a disease as per the current literature due to the presence of overlapping features . a 49-year - old female presented with hair loss from both center and sides of the scalp for the last 1 year which did not improve following minoxidil therapy . her family history was unremarkable , and she did not suffer from any chronic disease . no history of chronic medication could be elicited . personal and family history of photosensitivity was absent . on examination , we found scarring alopecia with follicular papules and mild scaling over the vertex [ figure 1a and b ] . she had definite recession of frontotemporal hairline with bilaterally symmetrical band - like scarring alopecia of the same region [ figure 2 ] . there were numerous violaceous follicular spinous papules distributed over the abdomen , back , arms , and legs [ figure 3a  c ] . ( b ) close - up view recession of frontotemporal hairline with symmetrical band - like scarring alopecia ( a ) violaceous follicular spinous papules over the abdomen . ( c ) violaceous follicular spinous papules over the leg nonscarring alopecia over the axilla routine investigations with complete hemogram , blood sugar , liver function test including hepatitis profile and thyroid screening were within normal limit . there was definite basal cell degeneration with band - like chronic inflammatory infiltrate around perifollicular region . all these features were consistent with lpp [ figure 5a and b ] . ( a ) follicular plugging with band - like chronic inflammatory infiltrate around perifollicular region , occasional loss of hair follicles , and perifollicular fibrosis ( h and e , 10 ) . ( b ) follicular plugging with definite basal cell degeneration with band - like chronic inflammatory infiltrate around perifollicular region ( h and e , 40 ) based on above findings , a diagnosis of glps with ffa was made , and the patient was put on oral prednisolone ( 1 mg / kg / day ) and oral retinoid ( 0.5 mg / kg / day ) for initial 2 weeks . dose of the steroid was tapered to 20 mg / day and continued along with the same dose of oral isotretinoin ( 20 mg ) for another 2 weeks with strict monitoring of blood parameters without any alteration . at the end of 1 month , the patient had significant improvement of pruritus and hair loss with flattening of the follicular papules . doses of steroid and isotretinoin were further reduced to 10 mg / day and 15 mg / day , respectively , for another 1 month with further flattening of follicular papules and improvement of ffa patch . now , the patient is on only 15 mg oral retinoid every alternate day and with regular follow - up on a monthly basis . the entity , glps was born with a lot of controversies as far as proper clinical definition is concerned . our observation of simultaneous presence of two variants may further add fire to the unsolved issues of this strange entity . glps is an unusual variant of lpp characterized by multifocal cicatricial alopecia of the scalp , noncicatricial alopecia of the axillae , and/or pubis and follicular lichen planus ( lp ) involving the trunk and extremities . on the other hand , this progressive form of fibrosing alopecia has failed to show any significant difference from other forms of lpp as far as histopathology and immunophenotyping are concerned . if we look into the pathogenesis , glps is generally considered of having an autoimmune origin . in ffa , the lymphocytic infiltrate and fibrosis affect selectively the intermediate and the vellus - like follicles of the frontal margin and eyebrows . although the reason for this selective involvement is still an enigma , it is hypothesized that it may represent a variety of lpp with selective involvement of certain androgen - dependent areas . the affected follicles may have typical biologic markers that could explain typical characteristic feature of ffa . there was several existing literatures where ffa was found to be associated with different forms of lp . in one report , authors concluded ffa as a phenotypic variation of glps where additional features are nonscarring alopecia of the eyebrow and axillae and follicular lp over the face . other authors described ffa in the association of cutaneous lp and oral mucosal lp . to the best of our knowledge , like our case , no such case has been reported till date where ffa is found along with full blown glps with all features . there are several treatment options available for lpp such as oral steroid , oral retinoid , cyclosporine , mycophenolate mofetil , hydroxychloroquine , and psoralen plus ultraviolet a therapy . surprisingly , our case responded very well in terms of symptomatic improvement , clearing of lesions , and halt of progressive alopecia . the classical and extensive presentation of glps along with concomitant ffa in the index case portrays a rare and unique presentation of follicular lp . such a coexistence of these two variants of lpp may be a mere overlap , a phenotypic variation of the same entity , or it may help in future to frame a newer nosology for lpp . the authors certify that they have obtained all appropriate patient consent forms . in the form the patient(s ) has / have given his / her / their consent for his / her / their images and other clinical information to be reported in the journal . the patients understand that their names and initials will not be published and due efforts will be made to conceal their identity , but anonymity can not be guaranteed . the authors certify that they have obtained all appropriate patient consent forms . in the form the patient(s ) has / have given his / her / their consent for his / her / their images and other clinical information to be reported in the journal . the patients understand that their names and initials will not be published and due efforts will be made to conceal their identity , but anonymity can not be guaranteed .