Prepubertal Fibrosing Alopecia in a Pattern Distribution

ABSTRACT Fibrosing alopecia in a pattern distribution (FAPD) is a cicatricial alopecia characterized by an androgenetic alopecia (AGA)-like pattern hair loss (PHL) associated with a lichen planopilaris (LPP)-like infiltrate on histopathology. Prepubertal PHL is the term proposed for AGA in children. The pattern is exclusively that of female PHL. We report the first case of FAPD in a child with prepubertal PHL. A 9-year-old girl initially presented with chronic itching, redness, and scaling of the central scalp area, which eventually developed to a cicatricial PHL with histopathological evidence of LPP. The implication of a follicular microinflammation and fibrosis associated with AGA has emerged from several studies. Ultimately, Zinkernagel and Trüeb reported a peculiar cicatricial PHL with histopathological features of LPP and named it FAPD. So far, FAPD has only been observed in adults. The observation of FAPD in a child with prepubertal PHL suggests that the condition is not androgen dependent and may explain the limited efficacy of 5-alpha reductase inhibitors for treatment of FAPD. The primary aims for treatment are anti-inflammatory in combination with a hair growth-promoting agent such as minoxidil.