Platelet Rich Plasma in the Treatment of Frontal Fibrosing Alopecia

Frontal Fibrosing Alopecia (FFA) represents a form of scaring alopecia more frequent in postmenopausal women that presents with frontal hairline recession. It is typically classified as a variant of lichen planopilaris. Treatment of FFA can be challenging with poor long-term outcomes. Platelet-Rich Plasma (PRP) consists of an autologous concentration of platelets in a small volume of plasma. Activated platelets secrete cytokines and growth factors and thus may have a potential role in the treatment of inflammatory scarring alopecia such as FFA. A 68-year-old female with multi-resistant FFA was treated with lesional PRP injections every 4 weeks for 16 weeks. Baseline LPPAI score and phototrichograms targeting a representative area of disease activity were compared at baseline and at 16 weeks. After 16 weeks, no significant change in follicular units or follicular density from baseline to week 16 was noted. Only a minimal improvement in inflammatory activity observed clinically and through the Lichen Planopilaris Activity Index was observed. The discordance between the follicular density count and observed inflammatory activity suggests a longer treatment and observational period is needed. Additionally, the frequency of PRP injections potentially may also need to be increased. Given the limited efficacy of current therapies for FFA, PRP injections may be an option in patients with refractory disease, as an adjunct to systemic therapy. Additional investigation is needed to optimize frequency of PRP injections in FFA and to better assess its true anti-inflammatory effect.

A New Vision about Folliculitis Decalvans and Lichen Planopilaris: Two Distinct Entities or a Continuous Phenotypic Spectrum?

Folliculitis decalvans and lichen planopilaris have been considered two distinct cicatricial alopecias. However, biphasic presentation of folliculitis decalvans - lichen planopilaris in the same patient has been recently described, therefore raising the doubt if they are two distinct entities or a continuous phenotypic spectrum.We describe the case of a man who presented clinical, trichoscopic, and histopathological features of both entities. Moreover, we discuss current theories about the pathogenesis of the two diseases and their coexistence in the same patient. The recognition of similar cases allows to optimize the approach and treatment.

Ultrasound Is Not Useful in Monitoring Lipedematous Alopecia: A Clinical, Trichoscopic, Histologic, and Ultrasound Analysis of 2 Cases

<b><i>Introduction:</i></b> Lipedematous scalp (LS) is a rare condition characterized by thickened adipose tissue in the subcutaneous layer of the scalp resulting in a soft, spongy, or thick consistency of the scalp. When associated with hair loss, this condition is called lipedematous alopecia (LA). Various imaging modalities have been used to diagnose LS and LA along with histopathology. <b><i>Case Presentation:</i></b> We present 2 cases of LS: a 56-year-old female with a 1-year history of hair thinning, pain, and tenderness at the vertex scalp and a 60-year-old female with a 5-year history of lichen planopilaris presenting with a 1-year history of itching and soreness on the crown of her head. Ultrasound (US) was used for diagnosis, treatment response surveillance, routine clinical examination, and symptom assessment. Follow-up US revealed no improvement in scalp thickness in either case despite symptom improvement and visual improvement in hair growth. <b><i>Discussion/Conclusion:</i></b> US has been reported as a helpful tool in the diagnosis of LS; however, treatment response was better approximated by hair growth and symptom alleviation. We found that once the diagnosis with made with US, clinical monitoring is adequate as symptom improvement and hair growth may not correlate with a change in scalp thickness.

A case of lichen planopilaris associated with lichen planus following Blaschko lines successfully treated with topical corticosteroid

Lichen planopilaris (LPP) is characterized by erythematous, keratotic follicular papules and cicatricial alopecia. LPP, the most common cause of cicatricial alopecia, is usually seen in women and causes significant psychosocial morbidity. We describe here a 42-year-old woman with a 6-month history of hair loss accompanied by itching on the scalp. Dermatological examination revealed patchy cicatricial alopecia in the vertex and band-like purple flat patches and plaques following the Blaschko lines on the right half of the body, together with post-inflammatory hyperpigmentation. Histopathological examination of the scalp biopsy was consistent with LPP, while thigh biopsy was consistent with lichen planus. With the histopathological and clinical evidence, our patient was evaluated as LPP associated with LP and successfully treated with topical corticosteroid. A few LPP and LP cases following the Blaschko lines have previously been reported separately. However, LPP, together with LP following Blaschko lines, have not been reported in the same patient.

Sexsomnia in a patient with lichen planopilaris and pulsed corticosteroid prescription

Sleep sex or sexsomnia is a relatively new disease that is considered an unusual sexual experience and behavior. Many facts about sexsomnia, including its causes, symptoms, and exact prevalence, are still unknown. Given that the symptoms of the disease occur accidentally during the night, it is tough to study this disease in the long run. This study reported a case of a 30-year-old man with sexsomnia who had no recollection of the sexual behavior he exhibited while asleep. He had lichen planopilaris and was not receiving any psychiatric medication at the time of the study. However, he was under treatment with corticosteroids for six months, which eventually worsened his depression. This behavior attracted his wife's attention, and he was referred to a doctor due to infertility.