BH27 When patterns blur: recognizing the overlap of alopecia areata and lichen planopilaris

Abstract We present the case of a 24-year-old man who presented with a 3-month history of progressive and expanding hair loss on the scalp. The patient had no prior history of hair loss or skin rashes, or personal or family history of autoimmune diseases. A clinical examination revealed erythema and perifollicular scaling on the scalp in addition to a patch of alopecia with characteristic exclamation-mark hair. Dermoscopy demonstrated yellow dots and accentuated perifollicular erythema and scaling. A punch biopsy was performed to investigate potential autoimmune pathology. Histological examination showed a hybrid pattern of nonscarring and scarring alopecia, characterized by inflammation surrounding hair follicles, concentric early scarring and perifollicular fibrosis. The clinical and histological findings were suggestive of overlapping conditions of concurrent alopecia areata and lichen planopilaris. Treatments to date have included triamcinolone injections, oral hydroxychloroquine and oral minoxidil, with some symptomatic relief and clinical improvement. This case emphasizes the importance of recognizing the overlap between alopecia areata and lichen planopilaris, which are rarely documented together, as well as the necessity for a comprehensive clinical and histological evaluation in atypical presentations of hair loss. The report contributes to the limited literature on this dual diagnosis and may guide future clinical management strategies for similar cases.