Ten clinical clues for the diagnosis of frontal fibrosing alopecia

Melo, Daniel Fernandes; Barreto, Taynara de Mattos; Albernaz, Elaine de Souza; Haddad, Natacha de Carvalho Mello; Tortelly, Violeta Duarte

doi:10.4103/ijdvl.ijdvl_713_17

Cited by 7 publications

(10 citation statements)

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“…FFA may cause pain, itching or burning sensations in the band across the frontal hairline (3). Additionally, our study reported various FFA-associated facial lesions.…”

Section: Trichoscopic Featuressupporting

confidence: 53%

“…Frontal fibrosing alopecia (FFA) is a distinctive form of primary lymphocytic cicatricial alopecia that affects mainly postmenopausal women (1,2). It presents clinically with progressive recession of the frontotemporal hairline and sometimes occipital hairline with inconsistent eyebrow hairloss (3). Pruritus, pain and burning can be observed in variable degrees on the affected sites (1).…”

Section: Introductionmentioning

confidence: 99%

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Frontal Fibrosing Alopecia: A prospective observational study

Kerouach¹,

Hali²,

Chiheb³

2023

World J. Adv. Res. Rev.

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Introduction: Frontal fibrosing alopecia (FFA) is a scarring alopecia of unknown etiology that affects mainly postmenopausal women. It is responsible for progressive recession of the frontotemporal hairline and sometimes occipital hairline with inconsistent eyebrow hair loss. We aimed to investigate the demographics, clinical and trichoscopic features of FFA in the Moroccan population. Patients and methods: We conducted a prospective study over a period of 2 years and 1/2, from January 2020 to July 2022. We enrolled twenty four patients, with clinical and/or histopathological diagnosis of FFA, seen at the dermatology department of Ibn Rochd University Hospital in Casablanca, Morocco. Data regarding demographics, clinical and trichoscopic findings were collected. Results: Twenty Four patients with FFA met the inclusion criteria. There were all women and half of them were postmenopausal (50%). The average age of disease onset was 46,95 years old. Pruritus was the most reported symptom (80%). An emotional factor was found in 40% of the cases and 45% of the patients reported the use of traditional products to their hairs. All patients presented with frontotemporal hairline recession with parietal or occipital involvement in 70% and 50% of the cases respectively, and 16 patients experienced eyebrow loss. Facial micropapules were found in 9 patients (45%), followed by patchy hyperpigmentation in 6 patients (30%) and follicular hyperpigmentation in 4 patients (20%). The majority of patients presented mild FFA (grades I and II), with a recession of less than 3 cm of the frontotemporal hairline (85%). The most frequent trichoscopic findings were perifollicular erythema (80%) and follicular hyperkeratosis (70%), followed by decreased or absence of vellus hairs (60%), lonely hairs (45%), perifollicular blue-gray pigmentation (35%), perifollicular brownish pigmentation (30%) and loss or absence of follicular openings (30%). Tufted hairs and white patches of scarring alopecia were found in 25% and 20% patients, respectively. Conclusion: Our study supports the role of cosmetic products or emotional factors in the physiopathology of FFA. Trichoscopy seems a valuable tool in the diagnosis of AFF. Perifollicular erythema, follicular hyperkeratosis and decreased of absence of vellus hairs are easily identified and are very suggestive of the diagnosis.

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“…FFA may cause pain, itching or burning sensations in the band across the frontal hairline (3). Additionally, our study reported various FFA-associated facial lesions.…”

Section: Trichoscopic Featuressupporting

confidence: 53%

Section: Introductionmentioning

confidence: 99%

Frontal Fibrosing Alopecia: A prospective observational study

Kerouach¹,

Hali²,

Chiheb³

2023

World J. Adv. Res. Rev.

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“…Due to a characteristic clinical pattern, the disease can be easily and effectively diagnosed clinically. In order to facilitate the identification of FFA, 10 signs have been established which may help clinicians in their everyday practice [52]: 1) high hairline due to cicatricial hairline recession; 2) difference in skin colour: pale skin of the affected area contrasts with normal facial skin containing signs of photodamage; 3) contraction of the frontal muscle (promoted by requesting the patient to raise the eyebrows) allows differentiation between frontal wrinkles and the marginal region of the scalp; 4) bilateral eyebrow loss; 5) more evident frontal veins: can be detected by palpation as a localized depression, near the original hairline, probably due to cutaneous atrophy; 6) disappearance of the vellus at the scalp hairline; 7) lonely hairs; 8) pseudo-fringe sign; 9) facial papules; 10) association with lichen planus pigmentosus; occurs frequently in patients with higher skin phototypes over photo-exposed areas.…”

Section: Clinical Examinationmentioning

confidence: 99%

Frontal Fibrosing Alopecia – a review and a practical guide for clinicians

Kępińska¹,

Jałowska²,

Bowszyc‐Dmochowska³

2021

Ann Agric Environ Med.

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Despite a significant increase in reported cases of frontal fibrosing alopecia (FFA) in literature, discussion about the possible role of environmental factors, instruction for diagnosis and guideline for treatment, are limited. The review aims to provide a detailed synthesis of this condition that could be used by clinicians in their practise. Whether single-centre or multicentre, studies of more than 60 cases less than 5 years old were mainly taken into consideration. Results obtained were that FFA affects mainly postmenopausal Caucasian women; the most common comorbidities are hyperlipidaemia, arterial hypertension, osteoporosis, hypothyroidism, depression, alongside dermatological disorders such as atopic dermatitis, rosacea, seborrheic dermatitis and androgenetic alopecia. Autoimmune, genetic, hormonal (e.g. estrogen deficiency, pregnancy, lactation, HRT and raloxifene) and environmental (e.g. daily use of facial sunscreens and less frequent use of hair dyes and shampoo) hypotheses were proposed for pathogenesis, as well as association with various predisposing factors (patient's health-social profile, disease's history and comorbidities). Clinical presentation of FFA can be divided into 3 specific patterns, each with a different prognosis. Diagnosis is usually made clinically with the use of trichoscopy; however, scalp biopsy remains the gold standard. The condition is regarded as a variant of lichen planopilaris (LPP) due to the similarity of the prominent histopathological findings, but the clinical image is distinct and therapeutic options vary. 5α-reductase inhibitors, intralesional steroids, and hydroxychloroquine provide the highest level of evidence for the treatment of FFA. The conclusion is that a better understanding of the disease is crucial for proper disease management.

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“…W przypadku braku leczenia linia nasady włosów ulega regresji z szybkością około 0,2-2,1 mm miesięcznie [7]. Choroba może również obejmować okolicę skroniową oraz potyliczną [12]. U 64% pacjentów dochodzi również do utraty brwi, szczególnie w 1/3 bocznej części, a stopień ich utraty może być czynnikiem prognostycznym przebiegu choroby.…”

Section: Wprowadzenieunclassified

“…0.2-2.1 mm per month [7]. The disease may also involve the temporal and occipital area [12]. In 64% of patients there is also loss of eyebrows,…”

Section: Introductionmentioning

confidence: 99%

Potential etiological factors in frontal fibrosing alopecia

Maciejewska¹,

Czuwara²,

Dąbrowska³

et al. 2022

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Frontal fibrosing alopecia is a variant of lichen planus, leading to permanent hair loss from the frontal hairline. It occurs mainly in postmenopausal women, however, the role of hormonal factors in the pathogenesis of this type of alopecia has not been determined. The coexistence of frontal fibrosing alopecia and autoimmune diseases is observed, e.g., hypothyroidism, rheumatoid arthritis, vitiligo, polymyositis, systemic lupus erythematosus and discoid lupus erythematosus. Considering the possible role of genetic factors, research is underway to identify human leukocyte antigen (HLA) polymorphisms. One of the most studied factors is sunscreen, widely used in cosmetic products. The data available so far in this regard are controversial. Factors raising significant doubts include: the retrospective nature of the research, basing the collected data on the self-assessment of respondents and the lack of specification of the ingredients of these products. In the light of current data, sunscreen components cannot be considered as a factor playing a role in the pathogenesis of frontal fibrosing alopecia. Overestimation of the role of sunscreens in hair loss could lead to unjustified avoidance of their use and contribute to increased incidence of skin cancer.

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Ten clinical clues for the diagnosis of frontal fibrosing alopecia

Cited by 7 publications

References 1 publication

Frontal Fibrosing Alopecia: A prospective observational study

Frontal Fibrosing Alopecia: A prospective observational study

Frontal Fibrosing Alopecia – a review and a practical guide for clinicians

Potential etiological factors in frontal fibrosing alopecia

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