Concurrent Lichen Planopilaris and Female Androgenic Alopecia in Skin of Color:A Case Series

Background: Trichoscopy findings can differ in the skin of color requiring a dedicated approach with adequate examination in order to ensure proper diagnosis and treatment. This case series details three cases of concurrent lichen planopilaris (LPP) and female androgenic alopecia (FAGA) in the skin of color. Methods: Gross examination of all cases revealed mild to moderate hair density thinning of the temporal and frontal scalp. Trichoscopy was done in all three cases before biopsy. The temporal scalp of each patient showed diffuse hair follicle miniaturization with minimal terminal hairs and brown follicular halos, all findings were consistent with FAGA. However, upon inspection of the frontal scalp, each case revealed findings associated with scarring alopecia including scale, erythema, and peripilar casts in addition to the presence of follicle miniaturization. Results: In the first two cases, two punch biopsies were taken, one from the temporal scalp and one from the frontal scalp. Temporal biopsy revealed FAGA and frontal biopsy revealed LPP arising in a background of AGA. In the third case, only the frontal scalp was biopsied, which showed LPP in a background of FAGA. All three cases received the same treatment regimen; clobetasol 0.05% solution and minoxidil 5% foam/solution topically for treatment of FAGA and monthly intralesional triamcinolone acetonide for treatment of the LPP. Conclusion: Our report suggests the importance of total scalp dermoscopy and the need for biopsies in areas with varying dermoscopy findings as opposed to areas with the most significant hair loss.