Peripilar “Guttate” Hypopigmentation of the Scalp and Idiopathic Guttate Hypomelanosis in Frontal Fibrosing Alopecia

Frontal fibrosing alopecia (FFA) is characterized by progressive band-like scarring alopecia involving the frontotemporal hairline and limbs and irreversible alopecia of the eyebrows. Two opposite types of pigmentary alterations have been reported in FFA: hyper- and hypopigmentation. Here, we report a 57-year-old Hispanic female with FFA who presented with peripilar hypopigmentation and idiopathic guttate hypomelanosis on the upper extremities. To our knowledge, this is the first report of peripilar white halos in a patient of a White Hispanic origin. Upon review of other previous publications on trichoscopy of FFA, this pattern has not been detected. The common pattern of focal absence of melanocytes and melanin in both is another confirmation that FFA is associated with pigmentation abnormalities.