Comments on the article: "Black women's hair: the main scalp dermatoses and aesthetic practices in women of African ethnicity"^*

The referred article presents an all-encompassing view regarding the hair of Afro-American women.¹

We consider relevant to emphasize an association observed with greater frequency in black patients: frontal fibrosing alopecia (FFA) and lichen planus pigmentosus (LPP).

Lichen planus pigmentosus is a variant of lichen planus with symptoms such as greyish, brownish or black macules, diffuse or reticulate, in photoexposed and flexural areas.^2,3 Histologically, it is characterized by hyperkeratosis, atrophic epidermis and vacuolar degeneration of the basal layer.²

The investigations which pointed out this correlation were carried out with African, Indian and Hispanic patients.^2-4 The conclusion was that it is more common in patients with higher phototypes, in which the prevalence of lichen planus pigmentosus is greater.⁵

In the Ambulatory of Trichology at the Hospital de Clínicas – UFPR we followed 79 patients with frontal fibrosing alopecia. Out of these, 8 are of mixed or black ethnicity and 2 presented lichen planus pigmentosus.

Another factor that should be highlighted is that Dlova² and Berliner⁴ demonstrated, in all of their cases, lichen planus pigmentosus lesions preceding the onset of frontal fibrosing alopecia. These pigmentary lesions may be considered "clues" for diagnostic aid between FFA and traction alopecia, especially in black patients, as well as early markers for a clinical picture of FFA still incipient.²

• Financial Support: None
• *
  Work performed at Hospital de Clínicas -Universidade Federal do Paraná (HC-UFPR) – Curitiba (PR), Brazil.

REFERENCES

• ¹
  Tanus A, Oliveira CC, Villarreal DJ, Sanchez FA, Dias MF. O cabelo da mulher negra: abordagem das principais dermatoses do couro cabeludo e das práticas estéticas das mulheres dessa etnia. An Bras Dermatol. 2015;90:450-65.
• ²
  Dlova NC. Frontal fibrosing alopecia and lichen planus pigmentosus: is there a link? Br J Dermatol. 2013;168:439-42.
• ³
  Rao R, Sarda A, Khanna R, Balachandran C. Coexistence of frontal fibrosing alopecia with lichen planus pigmentosus. Int J Dermatol. 2014;53:622-4.
• ⁴
  Berliner JG, McCalmont TH, Price VH, Berger TG. Frontal fibrosing alopecia and lichen planus pigmentosus. J Am Acad Dermatol. 2014;71:e26-7.
• ⁵
  López-Pestaña A, Tuneu A, Lobo C, Ormaechea N, Zubizarreta J, Vildosola S. Facial lesions in frontal fibrosing alopecia (FFA): Clinicopathological features in a series of 12 cases. J Am Acad Dermatol. 2015;73:987.e1-6.

Publication Dates

• Publication in this collection
  Sep-Oct 2016

History

• Received
  29 Nov 2015
• Accepted
  11 Jan 2016