DOI: https://doi.org/10.36347/sjmcr.2026.v14i07.014

Pages: 1666-1669

Alopecia areata and lichen planopilaris are immune-mediated alopecias with different follicular targets and prognoses, and their coexistence is rare. We report a 37-year-old woman with alopecia beginning at five years of age and pruritic hyperpigmented patches developing during adolescence. Examination showed diffuse non-scarring alopecia of the frontal and occipital scalp, scar-like temporal patches, subtle follicular papules, and loss of body hair. Trichoscopy demonstrated black and yellow dots in non-scarring areas and cicatricial changes in the temporal regions. A frontal scalp biopsy showed marked follicular miniaturization compatible with chronic alopecia areata, whereas a temporal biopsy showed interface folliculitis, peri-isthmic lymphocytic inflammation, perifollicular fibrosis, and sebaceous gland loss, supporting lichen planopilaris. Biopsy of a pigmented patch demonstrated basal hyperpigmentation, pigment incontinence, and dermal melanophages, consistent with lichen planus pigmentosus. Monthly intravenous corticosteroid pulses combined with methotrexate 20 mg weekly stabilized progression and produced slight scalp and eyebrow regrowth at one year, while pigmentation remained largely unchanged. This case emphasizes the need to examine different scalp zones separately and to target active areas for biopsy, because scarring and non-scarring alopecias may coexist and require different therapeutic priorities.