Clinical, Trichoscopic, and Histological Characteristics of 46 Hispanic Men with Fibrosing Alopecia in a Pattern Distribution: A Retrospective Multicenter Analysis

Luis Enrique Sanchez Dueñas^1*Irene Rodriguez²Joel Alejandro Ramírez-Sánchez¹Daniel Jimenez-Zaragoza^1*Guillermo Solis-Ledezma¹Guillermo Antonio Guerrero-Gonzalez³Miguel Marti-Machado⁴Mariana Lavia⁴Sonia Sofia Ocampo Garza⁵Lizet Rojano-Fritz⁶Aldo Gálvez-Canseco⁷Leslie Elizabeth Rocha-Mendez⁸Nicole Orendain-Koch⁹

• ¹Insituto Dermatologico de Jalisco "Dr. José Baba Rubio", Zapopan, Mexico
• ²Hospital General Dr Manuel Gea Gonzalez, Mexico City, Mexico
• ³Private Practice, Monterrey, Mexico
• ⁴Dr. Marti, Hair and Scalp Diseases Group, Buenos Aires, Argentina
• ⁵Department of Dermatology, Autonomous University of Nuevo, University hospital “Dr. José Eleuterio González”, Monterrey, Mexico
• ⁶Private Practice, Barranquilla, Colombia
• ⁷Private practice, Lima, Peru
• ⁸Private practice, León, Mexico
• ⁹Dermika laser dermatologic center, Guadalajara, Mexico

Background: Fibrosing alopecia in a pattern distribution (FAPD) is an infrequent presentation of primary cicatricial alopecia with clinical, histopathological and trichoscopic features of Androgenetic Alopecia (AGA), as well as Lichen Planopilaris (LPP). Objectives: The aim of this study is to describe the clinical, trichoscopic and histopathological features of 46 hispanic male patients with FAPD. Methods: This was a retrospective study from 8 dermatological centers across four countries: Argentina, Colombia, Mexico, and Peru. Patients with clinical diagnosis of FAPD performed by 12 dermatologists experienced in trichology from 2015 to 2022 were included. Results: Forty-six male patients were identified, with a mean age of 39. The age of onset ranged from 20 to 63 years. 85% of the patients (n=39) had a family history of AGA. In terms of clinical characteristics, the Male Pattern of Hair Loss (MPHL) was the most common (65%). All patients showed a symmetrical distribution of the alopecia. Regarding the trichoscopic characteristics, the most frequent finding was perifollicular desquamation (96%), while most common histological finding was concentric perifollicular lamellar fibrosis (100%). FAPD was the initial clinical suspicion in only 6 patients (13%), and androgenetic alopecia was the primary initial suspicion (56.5%). Conclusion: The age of onset of FAPD appears to be earlier in Latin American male patients compared with European and North American male patients. Most male patients with FAPD clinically resemble AGA in their classic pattern of hair loss.