Frontal fibrosing alopecia among men: A clinicopathologic study of 7 cases

Background: Frontal fibrosing alopecia (FFA) is a lichen planopilarisevariant scarring alopecia that has rarely been described in men. Objective: To characterize the clinicopathologic findings of FFA in men by studying a series of 7 male patients. Methods: We conducted a retrospective review of all cases of male patients with FFA at the Mayo Clinic from 1992 to 2016. Results: Seven male patients with FFA were identified. The frontal scalp (in 6 of 7 patients), sideburns (in 4 of 7), and temporal scalp (in 4 of 7) were most frequently involved. Three patients had involvement of the eyebrows. One patient had hair loss of the upper cutaneous lip. All patients had biopsy evidence of lichen planopilaris. None of the patients had associated autoimmune or thyroid disease. Two patients had hypogonadism upon testosterone studies. Limitations: Limitations include small sample size and varied follow-up. Conclusions: Although most often reported among postmenopausal women, FFA also occurs among men. The clinical and histopathologic characteristics of FFA in men parallel those described in women with FFA. Unique areas of involvement in men include sideburns and facial hair. Concomitant mucocutaneous lichen planus, autoimmune disease, and thyroid disease are infrequent among men with FFA. Distribution of hair loss and associated hormonal abnormalities aid in the recognition of FFA in men.