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