BACKGROUND: Frontal fibrosing alopecia (FFA) is considered a variant of lichen planopilaris affecting mainly the frontotemporal hairline. Since the first report in 1994, several other clinical features have been associated with the disease, such as facial papules (FP). Even though FP have been linked to facial vellus hair follicle involvement, how this finding alone could lead to the formation of clinically evident FP in FFA patients had not yet been addressed. OBJECTIVE: To describe histopathological findings of FP in the context of FFA and to highlight features that may be linked to their clinical formation. METHODS: Cutaneous FP biopsies of FFA patients performed between January 2016 and May 2017 were retrieved from our pathology database and reexamined by 2 pathologists. RESULTS: Histological sections of thirteen 3.0-mm punch biopsy specimens (2 horizontally and 11 vertically oriented) were collected from 7 patients. Eleven specimens demonstrated prominent sebaceous glands and 10 dilated sebaceous ducts. Pinkus acid orcein staining revealed reduction and fragmentation of the elastic fibers in 12 samples and, in 7 of these, this finding was observed in both the papillary and reticular dermis, particularly around sebaceous lobules. Vellus hair follicle involvement was only seen in 2 samples. CONCLUSIONS: Prominent sebaceous lobules with dilated ducts associated with an abnormal elastic framework seem to be the main explanation for the formation of FP in the context of FFA.
BACKGROUND: Frontal fibrosing alopecia (FFA) is considered a variant of lichen planopilaris affecting mainly the frontotemporal hairline. Since the first report in 1994, several other clinical features have been associated with the disease, such as facial papules (FP). Even though FP have been linked to facial vellus hair follicle involvement, how this finding alone could lead to the formation of clinically evident FP in FFA patients had not yet been addressed. OBJECTIVE: To describe histopathological findings of FP in the context of FFA and to highlight features that may be linked to their clinical formation. METHODS: Cutaneous FP biopsies of FFA patients performed between January 2016 and May 2017 were retrieved from our pathology database and reexamined by 2 pathologists. RESULTS: Histological sections of thirteen 3.0-mm punch biopsy specimens (2 horizontally and 11 vertically oriented) were collected from 7 patients. Eleven specimens demonstrated prominent sebaceous glands and 10 dilated sebaceous ducts. Pinkus acid orcein staining revealed reduction and fragmentation of the elastic fibers in 12 samples and, in 7 of these, this finding was observed in both the papillary and reticular dermis, particularly around sebaceous lobules. Vellus hair follicle involvement was only seen in 2 samples. CONCLUSIONS: Prominent sebaceous lobules with dilated ducts associated with an abnormal elastic framework seem to be the main explanation for the formation of FP in the context of FFA.
Authors: Sergio Vañó-Galván; Ana M Molina-Ruiz; Cristina Serrano-Falcón; Salvador Arias-Santiago; Ana R Rodrigues-Barata; Gloria Garnacho-Saucedo; Antonio Martorell-Calatayud; Pablo Fernández-Crehuet; Ramón Grimalt; Beatriz Aranegui; Emiliano Grillo; Blanca Diaz-Ley; Rafael Salido; Sivia Pérez-Gala; Salvio Serrano; Jose Carlos Moreno; Pedro Jaén; Francisco M Camacho Journal: J Am Acad Dermatol Date: 2014-02-05 Impact factor: 11.527
Authors: I Laniauskaite; M Ezmerli; T von Braunmühl; T Ruzicka; M J Flaig; H Wolff Journal: J Eur Acad Dermatol Venereol Date: 2016-05-26 Impact factor: 6.166
Authors: Sonali Nanda; Valeria De Bedout; Penelope A Hirt; David E Castillo; Thais Mesquita; Laura Scott; Mariya Miteva Journal: Skin Appendage Disord Date: 2019-09-18
Authors: María Librada Porriño-Bustamante; María Antonia Fernández-Pugnaire; Salvador Arias-Santiago Journal: J Clin Med Date: 2021-04-21 Impact factor: 4.241