Frontal Fibrosing Alopecia and Lupus Overlap in a Man: Guilt by Association?
A 46-year-old Caucasian male first presented with a 3 months' history of eyebrow thinning and itching. Past medical history included seborrhoeic dermatitis and rosacea. Examination showed erythematous eyebrows associated with pre-auricular and supra-auricular hair loss, deemed clinically to be non-scarring. One year later, photosensitivity at hair loss sites was noted. A left temple biopsy was consistent with scarring alopecia; direct immunofluorescence study was negative. Two years later, he developed further hair loss of scalp, eyebrows, beard, temples, [] and forearms [], and six years later complete loss of sideburns [].\nBiopsies from the scalp, eyebrow and arm showed follicular dropout and residual hair follicles with a perifollicular moderately dense lymphoid cell infiltrate with perifollicular fibrosis; consistent with LPP [Figures , and ] and in keeping with the clinical presentation of FFA. Periodic acid-Schiff stain of the scalp and eyebrow biopsies showed focal areas of basement membrane zone thickening []; direct immunofluorescence demonstrated a bright, granular-linear deposition of immunoglobulins IgM, IgG, IgA and fibrin along the basement membrane zone, consistent with a positive lupus band test []. Serological testing confirmed the presence of antinuclear, anticardiolipin, as well as lupus anticoagulant antibodies; however, he was free of systemic symptoms.