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Hair repigmentation in frontal fibrosing alopecia

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By Warren R. Heymann, MD
April 25, 2016

One of the major joys of practicing dermatology is that I’m stumped by something every day. Today an 81 year-old woman complained of months of hair loss along the frontal scalp with some loss of eyebrow hair. She had alopecia, follicular prominence, and the “lonely hair” sign. A classic case of FFA; clobetasol was prescribed. Then she said that “I used to love my white hair, but ever since this started, it’s getting darker, and I can’t stand it — either let it get real dark, or become white again”. I looked at her identifying image from last year in our EHR, and she’s absolutely right — her hair is repigmenting!

Repigmenting hair is rare — it has been reported in vitiligo, melanoma, annular elastolytic giant cell granuloma, and secondary to adalimumab.

Presumably, the lichenoid inflammatory infiltrate turns on the melanocytes — how, of course, is the $64,000 question (with inflation, now $6.4M).

To the best of my knowledge, she is the second such case in the literature. The first was reported by Defo et al (Hair darkening close to a patch of frontal fibrosing alopecia. Ann Dermatol Venereol 2006; 133: 799-801) describing repigmentation of white hair in a 78 year-old woman with biopsy-proven FFA.

Somehow, somewhere, someone will figure out the immunologic dynamics of cases like these that will make hair dye obsolete.

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