Akademik Veri Yönetim Sistemi
34th EADV Congress, Paris, Fransa, 17 - 20 Eylül 2025, cilt.18, ss.185, (Özet Bildiri)
Introduction & Objectives: Frontal fibrosing alopecia (FFA), considered a variant of lichen planopilaris, is a lymphocytic cicatricial alopecia that clinically presents with a receding frontotemporal hairline, along with perifollicular erythema and scale. Although not a common occurrence, the presence of pustules has been documented in FFA. Materials & Methods: In this case report, we present a female patient with cicatricial alopecia and follicular pustules in frontotemporal hairline who was diagnosed as pustular FFA based on clinical, trichoscopic and histopathological findings. Results: A 73-year-old female patient presented with pruritus and loss of frontotemporal hair and eyebrows for a period of 4 years. Her medical history included hypertension, chronic venous insufficiency and she was taking candesartan, hydrochlorothiazide, calcium dobesilat, diosmin and hesperidin. She did not describe any traction, sunburst or trauma. She declined any skin care routine. She had no relevant family medical history. Dermatological examination revealed recession of the frontotemporal hairline with multiple follicular pustules, lonely hair sign, and eyebrow loss. No facial papules were observed. Trichoscopic examination revealed perifollicular scaling and erythema, perifollicular pustules, reduced follicular ostia, milky red areas, white structureless areas, lonely hairs, decreased pigmentation of hair, pili torti. No tufted hairs were seen. Methicillin-sensitive S. aureus (MSSA) was found in the swabs taken from the intact pustules. Histopathological examination revealed follicular infundibuloisthmic involvement by lichenoid infiltration of lymphocytes and plasma cells, focal perifollicular mucinous fibroplasia, intraepidermal and intrafollicular pustule formation. The periodic acid-Schiff stain result ruled out the presence of a fungal infection. The patient was diagnosed with pustular FFA. Conclusion: Folliculitis decalvans and lichen planopilaris phenotypic spectrum is defined as the concurrent or sequential occurrence of clinical features of folliculitis decalvans and lichen planopilaris. The underlying pathogenesis has been suggested to result of hair follicle inflammation and immune privilege collapse in response to microbiome dysbiosis. This biphasic presentation includes pustules, tufted follicles, and histopathological neutrophilic infiltrate consistent with folliculitis decalvans and perifollicular erythema, scaling, cicatricial alopecia on the vertex, and histopathological lymphocytic infiltrate consistent with lichen planopilaris. In our patient, the findings were consistent with both folliculitis decalvans (presence of pustules, isolation of MSSA, neutrophilic infiltration) and FFA (regression in the frontotemporal hairline, lonely hair sign, eyebrow loss, reduced follicular ostia, lymphocytic infiltrate). A case of FFA and pustule presence similar to ours has been described in the literature. As with this case, it can be hypothesised that our case is consistent with pustular FFA, a newly identified variant within the spectrum. Further case reports are needed to facilitate a more comprehensive understanding of the characteristics of this variant.