Ulcerative keratitis in psoriasis: a rare variant of psoriatic ocular inflammatory disease

inflammation, as previously reported from eyebrow biopsies of patients with FFA. Follicular erythema on the cheeks has been reported in one case. It is possible that this feature and glabellar FRD both portray the same process. In that case, FRD in FFA would be a clinical sign not restricted to the glabellar region. However, such lesions were not biopsied and no histological correlation with LPP was established. Of note, none of our patients presented FRD on the cheeks. There is growing recognition that perifollicular erythema can persist in patients despite there being no progression in the hairline recession. Therefore, irrespective of their location, it is possible that FRD in patients with FFA might not always represent active inflammation, but the associated changes around the follicle induced by this condition, such as atrophy or vascular changes. In conclusion, we have reported three cases of FFA showing FRD in the forehead. A retrospective evaluation of 69 clinical pictures of FFA patients revealed three more patients presenting this pattern. Further data are needed in order to investigate the occurrence of glabellar FRD in other diseases; our preliminary findings suggest, however, that the clinician should regard this sign as indicative of vellus follicle involvement when observed in patients with FFA. Recent reports have expanded the clinical spectrum of FFA and it is conceivable that vellus follicle inflammation might also be seen more widely. The possibility of subclinical involvement of hair follicles in normal-appearing facial skin should be considered and future studies with histological analysis of such areas could investigate this aspect.