A Cross-sectional Study of Rosacea and Risk Factors in Women with Frontal Fibrosing Alopecia

Abstract

SIGNIFICANCEThe association between frontal fibrosing alopecia and rosacea is not clear. In this cross-sectional study, including 99 women with frontal fibrosing alopecia and 40 controls, women with frontal fibrosing alopecia presented a higher prevalence of rosacea than the controls did (61.6% vs. 30%), especially those with severe grades of alopecia (77.8% in grade V vs. 33.3% in grade I). Moreover, perifollicular erythema, higher body mass index and lower progesterone levels were associated with a higher risk of rosacea in the group with frontal fibrosing alopecia.Frontal fibrosing alopecia has been related to some auto immune diseases, but the association with rosacea is not clear. The objective of this study was to analyse the prevalence of rosacea in a group of patients with frontal fibrosing alopecia. A cross-sectional study, including 99 women with frontal fibrosing alopecia and 40 controls, was performed, in which clinical, dermoscopic and hormonal data were analysed. Women with frontal fibrosing alopecia presented a higher prevalence of rosacea than the controls did (61.6% vs. 30%, p = 0.001), especially those with severe grades of alopecia (77.8% in grade V vs. 33.3% in grade I, p = 0.02). Binary logistic multivariate analysis showed that perifollicular erythema (odds ratio (OR) 8.5; 95% confidence interval (95% CI) 1.73-42.30), higher body mass index (OR 1.16; 95% CI 1.01-1.34) and lower progesterone levels (OR 0.15; 95% CI 0.028-0.89) were associated with a higher risk of rosacea in patients with frontal fibrosing alopecia. In conclusion, patients with frontal fibrosing alopecia presented a higher prevalence of rosacea than did controls. Perifollicular erythema, higher body mass index and lower progesterone levels were associated with a higher risk of rosacea in the group with frontal fibrosing alopecia.

Frontal Fibrosing Alopecia: A Review

“…In a 355 patient cohort, the rate of early menopause (14%) was higher than in the general population (6%); moreover, 13% of patients had undergone a hysterectomy [ 3 ]. The mean time to the diagnosis reported in different studies is about 3.4 to 5.3 years [ 3 , 13 , 19 ]. Assessing the exact duration of the disease can be difficult sometimes, because its slow progression makes it complicated for the patient to detect the real time of onset.…”

“…In fact, a recent study about hormonal dysfunction found that LPP is associated with androgen excess (testosterone or DHEAS), whereas FFA is related to androgen deficiency (32.1% of patients) [ 52 ]. According to these findings, DHEAS and androstendione have been found to be lower in women with FFA compared to a control group [ 19 , 53 ]. Moreover, abnormal estrogen and testosterone values have been associated with lesser disease activity [ 18 ].…”

“…In the same study, the levels of luteinizing hormone (LH) and FSH were significantly lower in postmenopausal women with premenopausal onset in comparison to the ones with postmenopausal onset. Progesterone serum levels have also been noted to be lower in patients having both FFA and rosacea [ 19 ].…”

“…A high prevalence of atopy (43.9%) has been demonstrated in a FFA patients cohort [ 56 ]. However, according to different studies, one of the most frequently associated cutaneous condition seems to be rosacea, with a prevalence of 15 to 61% [ 19 , 55 , 56 ]. Interestingly, patients with more severe FFA appear to be more likely to have rosacea than those with mild grades of alopecia [ 19 ].…”

Platelet-Rich Plasma and its Use for Cicatricial and Non-Cicatricial Alopecias: A Narrative Review

“…It is a lymphocytic scarring alopecia characterized by progressive recession of the frontal and temporoparietal hairline. The eyebrows, eyelashes, and body hair can be affected [51,52].…”