[Did the Duchess of Urbino have frontal fibrosing alopecia?].

temporofrontoparietal hairline, and perhaps alopecia of both eyebrows, seen most clearly on the brow line. A contemporary bust of the Duchess at the Barguello Museum, also in Florence (Figure 2), would seem to confirm this impression as it bears a similar appearance. Arguments against PFFA include, primarily, her very young and definitely premenopausal age. However, this form of alopecia has occasionally been seen before the menopause4,5,7 and rare cases have even been known in men.8 Whatever the truth may be, this portrait presents us with a work of delicate beauty—where the jewels, brocades, and Throughout the history of art, painters have attempted to reflect both the beauty and imperfections of the human form on their canvases with greater or lesser success. There are “representations” of many skin diseases within works of art. In the absence of the complementary evidence needed to confirm clinical diagnosis, we must rely on astute observation alone to provide the foundation for our suspicions. Piero della Francesca’s painting The Duke and Duchess of Urbino hangs in Room 7, the early Renaissance section, of the Uffizi Gallery. The work consists of a pair of portraits depicting Federico de Montefeltro, Duke of Urbino, and his wife Battista Sforza (Figure 1). Our attention was drawn to the appearance of the Duchess, with a receding frontotemporoparietal hairline reminiscent of postmenopausal frontal fibrosing alopecia (PFFA). PFFA, described in 1994 by Kossard,1 mostly affects women aged between 49 and 83 years-old (mean, 64 years) and is characterized by a symmetrical recession of the frontotemporal hairline, causing a very characteristic band of pallid and uniform scarring alopecia. Associated alopecia of the eyebrows occurs in 62% of cases, and, less frequently, axillary alopecia. Histological findings vary with the developmental stage of the illness. Initially, there is lichenoid infiltrate in the upper part of the follicle that disappears as the illness advances and scarring alopecia sets in. Examination of the areas of alopecia reveals an absence of follicular orifices and, in some cases, follicular hyperkeratosis and perifollicular erythema.2-5 Battista Sforza, daughter of Alexander Sforza, Lord of Pesaro, was born in January 1446 and died aged 26 years old on July 6, 1472. The portrait of the Duke and Duchess of Urbino—the double portrait of Federico de Montefeltro and Battista Sforza we are looking at today—was completed after 1469, the year when Piero della Francesca first came to Urbino—a city where he painted other works including the Flagellation of Christ, the Senigallia Madonna, and the Madonna and Child with Saints. The portrait is a diptych showing Battista Sforza in profile, against the background of a landscape that possibly depicts the fields around Urbino. The Duchess has a curiously pale skin tone that some specialists have interpreted an indication that the portrait was commissioned posthumously.6 But could the Duchess have suffered from frontal fibrosing alopecia? Her appearance would seem to imply this: a band of alopecia producing a characteristic receding Did the Duchess of Urbino have Frontal Fibrosing Alopecia?