Refractory Alopecia Areata With Single Hairs Imitating Frontal Fibrosing Alopecia: A Prospective Observational Study

This study identifies a unique variant of alopecia areata (AA) that mimics frontal fibrosing alopecia (FFA) by presenting with single hairs and a receding hairline. Conducted with 18 patients, the research found that despite clinical similarities to FFA, the histopathology differed, showing a normal number of pilosebaceous units with one anagen hair and others in the telogen stage. The severity of hair loss, assessed by the SALT score, was no more than 50, and patients showed poor response to conventional therapy. The study highlights an increase in telogen hair follicles and minimal inflammation involving CD3+ T lymphocytes and mast cells in the microenvironment as the pathological basis for this AA variant.