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Histopathology of facial papules in frontal fibrosing alopecia and therapeutic response to oral isotretinoin

      To the Editor: We read with great interest that Pedrosa et al
      • Pedrosa A.F.
      • Duarte A.F.
      • Haneke E.
      • Correia O.
      Yellow facial papules associated with frontal fibrosing alopecia: a distinct histologic pattern and response to isotretinoin.
      were able to reproduce our findings regarding the histology of facial papules (FP) in frontal fibrosing alopecia (FFA) and the therapeutic response to isotretinoin. Our group first reported
      • Pirmez R.
      • Duque-Estrada B.
      • Barreto T.
      • Quintella D.C.
      • Cuzzi T.
      Successful treatment of facial papules in frontal fibrosing alopecia with oral isotretinoin.
      that histopathologic features of FP were not limited to perifollicular inflammation, as previously described,
      • Abbas O.
      • Chedraoui A.
      • Ghosn S.
      Frontal fibrosing alopecia presenting with components of Piccardi-Lassueur-Graham-Little syndrome.
      • Donati A.
      • Molina L.
      • Doche I.
      • et al.
      Facial papules in frontal fibrosing alopecia: evidence of vellus follicle involvement.
      and that structural changes involving elastic fibers and sebaceous glands could be responsible for the clinical formation of FP. Influenced by our observations, we performed a proof-of-concept study in which FP in a series of patients with FFA were successfully treated with oral isotretinoin. We wish to highlight some aspects and differences between our previously published observations and Pedrosa's work.
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      References

        • Pedrosa A.F.
        • Duarte A.F.
        • Haneke E.
        • Correia O.
        Yellow facial papules associated with frontal fibrosing alopecia: a distinct histologic pattern and response to isotretinoin.
        J Am Acad Dermatol. 2017; 77: 764-766
        • Pirmez R.
        • Duque-Estrada B.
        • Barreto T.
        • Quintella D.C.
        • Cuzzi T.
        Successful treatment of facial papules in frontal fibrosing alopecia with oral isotretinoin.
        Skin Appendage Disord. 2017; 3: 111-113
        • Abbas O.
        • Chedraoui A.
        • Ghosn S.
        Frontal fibrosing alopecia presenting with components of Piccardi-Lassueur-Graham-Little syndrome.
        J Am Acad Dermatol. 2007; 57: S15-S18
        • Donati A.
        • Molina L.
        • Doche I.
        • et al.
        Facial papules in frontal fibrosing alopecia: evidence of vellus follicle involvement.
        Arch Dermatol. 2011; 147: 1424-1427
        • Pirmez R.
        • Barreto T.
        • Duque-Estrada B.
        • Quintella D.C.
        • Cuzzi T.
        Facial papules in frontal fibrosing alopecia: beyond vellus hair follicle involvement.
        Skin Appendage Disord. 2018; 4: 145-149

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