Hyperpigmentation following Treatment of Frontal Fibrosing Alopecia
We present a 57-year-old postmenopausal female with a 3-year history of scarring alopecic plaques on both her frontotemporal regions, which she developed after an upper third face lift with aptos threads. Dermoscopy showed an absence of follicular openings, perifollicular scaling and erythema. Skin biopsy revealed the presence of a perifollicular lymphocytic infiltrate and lamellar fibrosis, a decrease of hair follicles and apoptotic cells in the external root sheath, therefore confirming the diagnosis of FFA (fig. ).\nTreatment was started with dutasteride 0.5 mg p.o. q.d. At the fifth month of follow-up, we added topical pimecrolimus 1% b.i.d. At this point, the patient presented a 40% improvement in erythema and even showed slight hair regrowth.\nEight months after the treatment was started, the patient presented hyperchromic macules in the metacarpophalangeal and interphalangeal joints of both hands as well as on the cheeks and chin (fig. ); she denied the use of other concomitant treatments. A skin biopsy was performed, revealing basal layer membrane hyperpigmentation.\nTreatment was stopped and the use of photoprotection was encouraged. Five months after the treatment was discontinued, the patient showed an 80% improvement of her hyperpigmented lesions (fig. ).