In this series, we will take you through real life cases (using assumed names), to give you an in depth understanding of the various conditions that can affect the scalp. This particular case study is about Swati, 55yr old female who was diagnosed with frontal fibrosing alopecia. Given here are the features, causes, diagnosis and treatment that was administered to her.
Features: When Swati first walked into our clinic, she came with history of massive hair loss from the frontal side. We observed that hair loss was present over the front part of her scalp almost in a straight line backwards and there was some amount of associated scarring. She was put through a basic hair and scalp analysis. We also noted that there was an almost symmetric band like loss of hair, on the front part of her scalp, as well as towards the side. The skin where the hair loss had taken place, looked more or less normal, with a slight amount of scarring. On closer inspection, we were able to see the redness and the scaling. This helped us to diagnose the condition as frontal fibrosing alopecia, where the frontal part of the scalp was affected. The condition normally affects women over the age of 50.
Causes: We informed Swati that the cause is usually unknown; however, it is thought to be a variant of the disease called lichen planus where the body’s immune system is at fault. The immune response to certain components of the hair follicles becomes fault ridden, and that might be the cause for the condition. Since the condition appears post menopause, we feel that there might be certain hormones in play and relayed the same to Swati as well.
Diagnosis: Our first step was to inform Swati that this condition tends to progress slowly, but does stabilise after a while. We then moved onto confirming our diagnosis, for which we conducted a scalp biopsy. We harvested the hair follicles that had been affected recently and these were encircled by inflammatory cells in lichenoid pattern.
Treatment:We put Swati on a course of steroid pills and anti-inflammatory antibiotics and were able to contain the condition. After the disease has become stable for over a year, we were able to conduct a transplant procedure on her, allowing her to style her hair in a normal manner.