When to Suspect Frontal Fibrosing Alopecia

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Frontal Fibrosing Alopecia Forehead Veins

Suspect frontal fibrosing alopecia in women presenting with prominent superficial veins radiating from the lower forehead to the frontal hairline. A patient presented to me concerned she had the en coup de sabre form of linear morphea. After consulting Dr Google, she was very concerned of progression to severe hemifacial atrophy. Physical examination showed prominent veins, palpable frontal bony atrophy but normal skull X-ray, thinning of the lateral eyebrows, and early frontal hairline regression. The dermatology literature has reported other cases of prominent forehead veins associated with frontal fibrosing alopecia and not linear morphea. I reassured the patient about the veins and discussed how to treat scarring alopecia.

Wayne Fujita, MD
Aiea, HI

Dealing With Fixed Beliefs

If patients have used the internet and have fixed beliefs that I consider inaccurate, I do not argue with them. Instead, to establish rapport and trust, I tell them how glad I am they took the time to educate themselves and that too few people do. I tell them, “What a relief, finally a patient I can talk to at my level. You would not believe how many people come here without first educating themselves on the internet.”

Steven R. Feldman, MD, PhD
Winston-Salem, NC

Usefulness of Wipes

Cetaphil, CeraVe, Bioderma, or other company wipes/cloths are useful (and sometimes free for us) for removing cantharone, before a cosmetic patient has a peel/microdermabrasion/ facial to cleanse the skin, and as a gentle makeup remover.

Benjamin Barankin, MD, FRCPC
Toronto, Ontario, Canada