The follicular triad: a pathological clue to the diagnosis of early frontal fibrosing alopecia

Funding sources: None. Conflicts of interest: None declared. Madam, Frontal fibrosing alopecia (FFA) is a clinical variant of lichen planopilaris (LPP), which mostly affects postmenopausal women and frequently involves the eyebrows.1 It presents as a progressive symmetric band‐like alopecia involving the frontal hairline, the preauricular and, less commonly, the retroauricular scalp. The partial or complete hair loss of the eyebrows without clinical inflammation is characteristic and occurs either before or after the onset of frontotemporal recession.2 The condition usually advances slowly (0·9 mm a month) and eventually stabilizes. There is current evidence that, in FFA, vellus or terminal hair follicles of the face, including the eyelashes, as well as extrafacial body sites may also be affected by hair loss.3 We recently reported that biopsies obtained from limb alopecia and scalp alopecia in FFA share the same histopathological features, i.e. a LPP pattern.4 This finding was confirmed by two recent publications.3, 5