Hair repigmentation in frontal fibrosing alopecia
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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