Asian Journal of Research in Dermatological Science

“Folliculitis Decalvans and Lichen Planopilaris” Phenotypic Spectrum: Report of Three Cases

Amani Fliti *

Department of Dermatology and Venerology, University Hospital Center Ibn Sina, University of Mohamed V, Rabat, Morocco.

Meryem Elomari Alaoui

Department of Dermatology and Venerology, University Hospital Center Ibn Sina, University of Mohamed V, Rabat, Morocco.

Karrakchou Bamsa

Department of Dermatology and Venerology, University Hospital Center Ibn Sina, University of Mohamed V, Rabat, Morocco.

Azendour Hasna

Department of Dermatology and Venerology, University Hospital Center Ibn Sina, University of Mohamed V, Rabat, Morocco.

Senouci Karima

Department of Dermatology and Venerology, University Hospital Center Ibn Sina, University of Mohamed V, Rabat, Morocco.

Mariame Meziane

Department of Dermatology and Venerology, University Hospital Center Ibn Sina, University of Mohamed V, Rabat, Morocco.

*Author to whom correspondence should be addressed.

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Abstract

Introduction: folliculitis decalvans (FD) and lichen planopilaris (LPP) are two primary cicatricial alopecias (neutrophilic and "lymphocytic," respectively) recently associated in a phenotypic spectrum. The "folliculitis decalvans and lichen planopilaris" phenotypic spectrum FDLPPPS is a combination of the clinical and histological features of FD and LPP. Our study aims to analyze three cases of a specific disease to better understand its clinical characteristics, evolution, and treatment.

Materials and Methods: We reported 3 cases of FDLPPPS with clinical manifestations, trichoscopy, histopathological features, treatments, and follow-up findings as a new presentation of this spectrum.

Results: We reported 3 cases; two females, and one male, with an average age of 33 years (ranging from 20 to 42 years). The average duration of disease evolution before diagnosis was 6.3 years (ranging from 1 to 10 years). Clinically, they presented with one or multiple alopecic patches on the vertex with pustules and crusts and a receding frontal hairline in one patient. Dermoscopy revealed signs consistent with lichen planopilaris and folliculitis decalvans. A diagnosis of phenotypic spectrum was established through histology. Patients received treatments including corticosteroids, antibiotics, hydroxychloroquine, or isotretinoin, with good improvement noted in one patient, moderate improvement in another, and stabilization in the third.

Conclusion: This phenotypic spectrum is a newly recognized entity that combines clinical and histological signs of FD and LPP. Early treatment is crucial to halt disease progression. The emergence of new variants within FDLPPPS, such as FD-frontal fibrosing alopecia, underlines the need for further case series to better characterize this spectrum.

Keywords: Phenotypic spectrum, lichen planopilaris, folliculitis decalvans, trichoscopy, fortnal fibrosing alopecia, alopecia

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References

Olsen EA, Bergfeld WF, Cotsarelis G, et al. Summary of North American hair research society (NAHRS)-sponsored Workshop on cicatricial alopecia, Duke University Medical Center, February 10 and 11, 2001. Am Acad Dermatol. 2003;48:103-10.

Folliculitis decalvans and lichen planopilaris phenotypic spectrum: A case series of biphasic clinical presentation and theories on pathogenesis. Yip L, Barrett TH, Harries MJ. Clin Exp Dermatol. 2020; 45(1):63-72. DOI:10.1111/ced.13989. PMID: 31017678.

Karrakchou B, Fliti A, El Fiboumi A, Kettani F, Senouci K, Meziane M. Folliculitis decalvans with frontal fibrosing alopecia in a dark phototype: Presentation of folliculitis decalvans and lichen planopilaris phenotypic spectrum. Dermatol Pract Concept. 2023;13(4): e2023229 DOI https://doi.org/10.5826/dpc.1304a229

Morais KL, Martins CF, Anzai A, Valente NYS, Romiti R. Lichen planopilaris with pustules: a diagnostic challenge. Skin Appendage Disord 2018;4:61-6.

Egger A, Stojadinovic O, Miteva M. Folliculitis decalvans and lichen planopilaris phenotypic spectrum-a series of 7 new cases with focus on histopathology. Am J Dermatopathol 2020; 42:173-7.

Ramos PM, Miot HA. Exuberant tufted folliculitis. An Bras Dermatol 2019;94: 115-6.

Zhang X, Zhu M, Zhou J, Wu S, Liu J, Qin Q. Folliculitis Decalvans and Lichen Planopilaris Phenotypic Spectrum: A Case Report. Clin Cosmet Investig Dermatol. 2022 May 31;15:993-996. DOI: 10.2147/CCID.S365566. PMID: 35677221; PMCID: PMC9167836.

Bolduc C, Sperling LC, Shapiro J. Primary cicatricial alopecia: Lymphocytic primary cicatricial alopecias, including chronic cutaneous lupus erythematosus, lichen planopilaris, frontal fibrosing alopecia, and Graham -Little syndrome. J Am Acad Dermatol. 2016; 75:1081-99. DOI: 10.1016/j.jaad.2014.09.058.

Bolduc C, Sperling LC, Shapiro J. Primary cicatricial alopecia: Other lymphocytic primary cicatricial alopecias and neutrophilic and mixed primary cicatricial alopecias. J Am Acad Dermatol. 2016;75: 1101-7. DOI: 10.1016/j.jaad.2015.01.056.

Bernárdez C, Molina-Ruiz AM, Requena L. Histologic features of alopecias: part II: scarring alopecias. Actas Dermosifiliogr. 2015;106:260-70. DOI: 10.1016/j.ad.2014.06.016.

Kang H, Alzolibani AA, Otberg N, Shapiro J: Lichen planopilaris. Dermatol Ther 2008; 21: 249–256.

Lobato-Berezo A, González-Farré M, Pujol RM. Pustular frontal fibrosing alopecia: a new variant within the folliculitis decalvans and lichen planopilaris phenotypic spectrum? Br J Dermatol. 2022;186(5): 905-907. DOI: 10.1111/bjd.20962. PMID: 34939665.