CLINICOPATHOLOGIC SPECTRUM OF FACIAL PAPULES: A SILENT PRESENTING FEATURE OF FRONTAL FIBROSING ALOPECIA

Summary: Facial papules (FP) are a recently described clinical manifestation of Frontal fibrosing alopecia (FFA). They typically present as asymptomatic, skin coloured to yellowish-white monomorphic and non-inflammatory papules that result from destruction of the facial vellus hair follicles with subsequent prominence of the sebaceous glands. We present 4 female patients (mean age: 44 years), with either a clinical or histopathological diagnosis of FFA, presenting with multiple tiny and monomorphic asymptomatic papules distributed on the face. Histopathological examination of these lesions revealed sebaceous glands prominence, with or without a vellus perifollicular lymphocytic inflammation, in keeping with FP associated with FFA. Facial papules have been reported in up to 22% of FFA patients and are more frequently seen pre-menopausal women. There have been descriptions of FP occurring early in the course of FFA, and prior to the scalp hair loss, thus representing an early diagnostic sign for FFA. Indeed, in 2/4 of our cases, FP preceded the onset of hair loss. We underscore the importance of this clinicopathological finding in the early diagnosis and management of patients with FFA.