Postmenopausal Frontal Fibrosing Alopecia (Kossard)

We report on a 67-year-old female patient with characteristic clinical and histological features of postmenopausal frontal fibrosing alopecia (PFFA). PFFA, first described by Kossard in 1994, is a rare condition that predominantly occurs in postmenopausal women developing a fibrosing bandlike alopecia associated with progressive recession of the frontoparietal hairline and loss of the eyebrows. Histological features consisting of perifollicular lymphocytic infiltrates and concentric fibrosis around the isthmus and infundibular region are identical with those of lichen planopilaris. PFFA cannot unequivocally be distinguished from other fibrosing disorders such as lichen planopilaris or ulerythema ophryogenes. Management (e.g. glucocorticoids, retinoids or chloroquin) is usually unsatisfactory, particularly in the fibrosing stage of disease.