Male frontal fibrosing alopecia: study of 35 cases and association with sunscreens, facial skin and hair care products

Abstract

BW/day). 8 In TEN, cessation of the causing agent, high-dose intravenous immunoglobulins together with systemic steroids are recommended. 9 The prognosis of both conditions is generally very poor: in our patient the severity-of-illness score for TEN (SCORTEN) was 4, predicting a mortality rate of 58.3%. 4,9 In acute grade IV, cutaneous GvHD long term survival (>5 years) is only 5%. 10 We report a TEN-like acute cutaneous GvHD in a stem cell recipient, which caused a diagnostic dilemma as clinical and histopathological findings of TEN and GVHD are overlapping. As therapeutic recommendations differ between these two lifethreatening conditions, a distinction of cutaneous GvHD and TEN is very important. In our case, the presence of painless skin lesions, the distribution and evolvement of the exanthema led us favour the diagnosis of cutaneous GvHD.

Clinical characteristics of male frontal fibrosing alopecia: a single-centre case series from London, UK

“…While many clinical features of male FFA were similar to those reported in our female cohort, 2 the median age of onset was younger and features such as facial hair loss and facial papules were prominent. Our male FFA cohort was also comparable to several other case series of male FFA, although our participants had a younger median age of onset and less frequent comorbidity with androgenetic alopecia 3–6 . Interestingly, an excess of autoimmune comorbidity compared with general population estimates was noted, as were signs of male hormone imbalance 7,8 .…”

“…Mycoplasma-induced SJS/TEN is increasingly reported as having unique clinical features, including sparse cutaneous involvement, prominent mucositis or possibly a milder phenotype. [4][5][6] However, this is inconsistent with our series where proven Mycoplasma infection was associated with widespread cutaneous disease (TEN) and recurrent episodes. Not all the milder cases were tested for Mycoplasma and we cannot exclude undiagnosed Mycoplasma infection.…”

“…Our male FFA cohort was also comparable to several other case series of male FFA, although our participants had a younger median age of onset and less frequent comorbidity with androgenetic alopecia. [3][4][5][6] Interestingly, an excess of autoimmune comorbidity compared with general population estimates was noted, as were signs of male hormone imbalance. 7,8 These observations suggest that male FFA may involve hair-specific autoimmunity and that sex hormone abnormalities may be relevant to its pathogenesis, possibly via their modulation of pathogenic, hair-specific immune responses.…”

“…1,2 Nonetheless, men comprise 3-5% of patients affected by FFA and the male FFA phenotype, including clinical manifestations and comorbidities, has been incompletely characterized in the literature. [3][4][5][6] Here, we describe the male FFA phenotype in a case series of 17 men with FFA presenting to St John's Institute of Dermatology, London, UK.…”

Lichen Planus

“…The most commonly implicated drugs (Table 2) are angiotensinconverting enzyme inhibitors, thiazide diuretics, antimalarials, anti-inflammatory drugs, antimicrobials, antihypertensives, psychiatric drugs, antidiabetics, PD-1-inhibitors, quinidine, penicillamine, and metals (62)(63)(64)(65). Another peculiar potential environmental trigger for LP is UV-filters in sunscreens and hair-care products that have been noted to be associated with frontal fibrosing alopecia and lichen planopilaris (66,67).…”