Frontal fibrosing alopecia: when the treatment is worse than the disease

Frontal Fibrosing Alopecia (FFA) is a type of primary lymphocytic scarring alopecia, clinically characterized by a distinctive pattern of progressive frontotemporal hairline recession and eyebrow loss. The etiopathogenesis of FFA is unknown, but it is widely considered a variant of lichen plano-pilaris usually, but not exclusively, affecting postmeno - pausal women. Current treatment aim to stop the disease progression, but no standardized treatment are recommended, and best results from observational studies have been reported for 5- reductase inhibitors and intralesional corticosteroids, followed by antimalarials and calcineurin inhibitors. Here, we report a 52-year-old postmenopausal woman with a 7-year history of FFA, who experienced a severe worsening after treatment with intralesional triamcinolone acetonide, for the occurrence of steroid induced skin atrophy. Whether the physician has undervalued the well-known side effect of intralesional steroids or the peculiar fibrosing tendency of the disease has played a role is difficult to assess. No previous report of steroid induced atrophy in FFA was retrieved from the current literature. This case draws attention on the importance to properly estimate the consequences of medical interventions in disorders with exclusive aesthetic impact.