LICHEN-PLANOPILARIS PRESENTING AS POSTMEN OPAUSAL FRONTAL FIBROSING ALOPECIA (KOSSARD)

A 68-year old woman presented with a frontal fibrosing alopecia and le sions of the buccal mucous membranes typical for lichen planus. Postme nopausal frontal fibrosing alopecia (PFFA) has recently been described by Kossard as a distinct entity characterized by progressive recessio n of the frontotemporal and parietal hair margins leading to permanent alopecia in the form of a symmetrical band-like area of scarring in p ostmenopausal women. The histology (perifollicular lymphocytic infiltr ation and fibrosis, increase of apoptosis of hair follicle keratinocyt es) is indistinguishable from that of lichen planopilaris. The localiz ation and age-and sex-related characteristics of PFFA are not sufficie nt to delineate it as a discrete entity from lichen planopilaris. Our observation of oral lichen planus in a postmenopausal woman with front al fibrosing alopecia points to the possibility that PFFA actually may represent a variant of lichen planopilaris with a predilection for th e frontotemporal hairline. Other variants of lichen planopilaris inclu de multifocal lichen planopilaris,disseminated lichen planopilaris (La ssueur-Graham-Little syndrome),lichenoid pseudopelade,and any combinat ion of these (''mixed type''). An effective therapy of PFFA is not kno wn. Also, treatment of lichen planopilaris forms in which fibrosis pre dominates over inflammation is similarly problematic, but the natural course of these diseases seems to be self-limited.