Fibrosing alopecia in a pattern distribution

Jacob Griggs, Ralph M. Trüeb, Maria Fernanda Reis Gavazzoni Dias, Maria Hordinsky, Antonella Tosti

Research output: Contribution to journalReview articlepeer-review

31 Scopus citations


Background/Objectives: Fibrosing alopecia in a pattern distribution (FAPD) is a newly recognized form of scarring alopecia sharing characteristics of both androgenetic alopecia (AGA) and lichen planopilaris. The existing literature on FAPD and current understanding of the epidemiology, pathogenesis, clinical features, diagnosis, and treatment of this disease are reviewed. Methods: PubMed searches were performed to identify all articles discussing FAPD. The references of articles were used to identify additional articles. Results: A total of 15 articles were found describing FAPD in a total of 188 patients (164 women and 24 men; average age, 53.8). Conclusions: FAPD affects the androgen-dependent scalp and is typically associated with hair follicle miniaturization. The scalp affected by FAPD shows features of both lichen planopilaris and AGA, and FAPD may possibly represent an exaggerated inflammatory response to damaged hair follicles, triggered by AGA. Physical examination and trichoscopic evidence of follicular inflammation and, occasionally, fibrosis are important to identify the condition, and a dermoscopy-guided biopsy can confirm the diagnosis. Unless recognized, clinicians may misdiagnose FAPD as AGA associated with seborrheic dermatitis. Data on treatment modalities are limited; however, based on pathogenesis, combined therapy with anti-inflammatory and hair growth–promoting agents is warranted.

Original languageEnglish (US)
Pages (from-to)1557-1564
Number of pages8
JournalJournal of the American Academy of Dermatology
Issue number6
Early online dateJan 8 2020
StatePublished - Dec 2021

Bibliographical note

Publisher Copyright:
© 2020 American Academy of Dermatology, Inc.


  • FAPD
  • androgenetic alopecia
  • central centrifugal cicatricial alopecia
  • cicatricial alopecia
  • fibrosing alopecia in a pattern distribution
  • frontal fibrosing alopecia
  • lichen planopilaris
  • scarring alopecia

PubMed: MeSH publication types

  • Journal Article
  • Review


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