Frontal fibrosing alopecia: A review of 60 cases

• Published in: Journal of the American Academy of Dermatology Vol. 67; no. 5; pp. 955 - 961
• Main Authors: MacDonald, Alison, MRCP, Clark, Colin, FRCP, Holmes, Susan, FRCP, MD
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01-11-2012; Elsevier
• Subjects: Adult; affluence; Aged; alopecia; Alopecia - diagnosis; Alopecia - immunology; Alopecia - pathology; Autoimmunity; Biological and medical sciences; Calcineurin Inhibitors; Dermatology; Female; frontal fibrosing alopecia; Glucocorticoids - administration & dosage; Hair and nails disorders; Humans; lichen planopilaris; Medical sciences; Middle Aged; origin; prognosis; Retrospective Studies; treatment; Treatment Outcome; Triamcinolone - administration & dosage; FFA; treatment; angiotensin-converting enzyme inhibitors; frontal fibrosing alopecia; LP; NSAID; origin; prognosis; lichen planus; LPP; alopecia; autoimmunity; affluence; ACEI; lichen planopilaris; nonsteroidal anti-inflammatory drug; Hair; Skin disease; Dermatology; Bibliographic review; Scarring alopecia
• ISSN: 0190-9622; 1097-6787
• DOI: 10.1016/j.jaad.2011.12.038

Background Frontal fibrosing alopecia (FFA) is a variant of lichen planopilaris primarily affecting postmenopausal women, with a predilection for the frontotemporal hairline. Objectives We sought to examine possible causal associations and review the clinical features, natural history, and response to treatment of patients with FFA attending a specialist hair clinic. Methods This was a case note review of 60 patients with FFA. Results The number of patients with FFA seen has increased over the last decade. All were Caucasian women, with significantly above-average affluence scores and were less likely to be smokers. The mean age at presentation was 64 years and average disease duration was 3.4 years (range: 6 months-30 years). Three patients were premenopausal. All patients had frontotemporal involvement, with follicular hyperkeratosis, scarring, and variable perifollicular erythema. Several patients had more unusual patterns: 8 had extensive parietal involvement, 4 had occipital involvement, 1 had asymmetric frontal involvement, and 5 had typical FFA associated with diffuse scalp lichen planopilaris. Eyebrow loss was documented in 73%, eyelash loss in 3%, and body hair loss in 25%. Almost all patients had been treated with superpotent topical steroids. Other treatments included topical calcineurin inhibitors; intralesional triamcinolone acetate; phototherapy; hydroxychloroquine; lymecycline; and prednisolone. Although some treatments may reduce inflammation, their efficacy in controlling the progress of the alopecia was uncertain. Limitations This is a retrospective review. Conclusions FFA is a clinically distinctive condition, the prevalence of which appears to be increasing. It has a generally poor response to treatment. The origin remains uncertain.