Clinical and Dermoscopic Approaches to Diagnosis of Frontal Fibrosing Alopecia: Results From a Multicenter Study of the International Dermoscopy Society

February 2022 in “ Dermatology practical & conceptual ”

Michela Starace, Gloria Orlando, Matilde Iorizzo, Aurora Alessandrini, Francesca Bruni, Victor Desmond Mandel, Kelati Awatef, Horacio Cabo, Gabriella Fabbrocini, Hanane Baybay, Sven Lanssens, Alejandro Lobato‐Berezo, Fatima Zahra Mernissi, John Paoli, Angela Patrì, Emilia N. Cohen Sabban, Martyna Sławińska, Michał Sobjanek, Oscar Zaar, Giovanni Pellacani, Bianca Maria Piraccini

Frontal Fibrosing Alopecia FFA Lichen Planopilaris LPP Androgenetic Alopecia AGA alopecia trichoscopy inflammatory signs itching frontal hairline recession lichen planus of the scalp male pattern baldness hair loss scalp examination scalp inflammation scalp itching

Studysummary This study found that trichoscopy is an effective noninvasive technique for diagnosing frontal fibrosing alopecia, confirming its valuable role alongside traditional histopathological examination.

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The study presents a large cohort of patients diagnosed with Frontal Fibrosing Alopecia (FFA), a disease that primarily affects postmenopausal women (88.1%) but can also occur in younger women (11.9%) and men. The average age at onset was 58.6 years. The study found an association between FFA and Lichen Planopilaris (LPP) in 18.6% of cases, supporting the theory that FFA could be a clinical variant of LPP. Androgenetic Alopecia (AGA) was present in 38.8% of patients, suggesting a possible shared pathogenetic mechanism with FFA. The diagnosis of FFA was typically made 4.4 years after the onset of the disease, often at a severe stage, highlighting the need for increased awareness and early diagnosis. Alopecia of the eyebrows was the most common sign of the disease, found in 85.6% of cases. Trichoscopy was a useful tool in diagnosing milder cases and differentiating FFA from other conditions. Inflammatory signs were present in over 60% of patients, and 65.9% reported itching. The study suggests further research into non-invasive imaging techniques for diagnosing FFA.

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Guidelines for Clinical Trials of Frontal Fibrosing Alopecia: Consensus Recommendations from the International FFA Cooperative Group

research Guidelines for Clinical Trials of Frontal Fibrosing Alopecia: Consensus Recommendations from the International FFA Cooperative Group

14 citations , June 2021 in “British journal of dermatology/British journal of dermatology, Supplement”

This paper presents consensus guidelines for standardized diagnostic criteria and assessment methods for frontal fibrosing alopecia to improve clinical research and data collection globally.

research Optimal Management of Frontal Fibrosing Alopecia: A Practical Guide

3 citations , November 2020 in “Clinical, Cosmetic and Investigational Dermatology”

This review summarizes the current treatment modalities for frontal fibrosing alopecia and provides a practical guide for clinicians, but reports no new clinical results.

research Medical Comorbidities and Sex Distribution Among Patients With Lichen Planopilaris and Frontal Fibrosing Alopecia: A Retrospective Cohort Study

22 citations , August 2020 in “Journal of the American Academy of Dermatology”

Women with lichen planopilaris and frontal fibrosing alopecia often have other health issues like hypothyroidism and lupus.

research Frontal Fibrosing Alopecia and Genital Lichen Sclerosus: Single-Center Experience

10 citations , June 2020 in “Journal of Cosmetic Dermatology”

This study found a high prevalence of genital Lichen sclerosus and autoimmune comorbidities in patients with frontal fibrosing alopecia, suggesting a possible shared autoimmune process.

research Frontal Fibrosing Alopecia: Demographic and Clinical Characteristics of 490 Cases

53 citations , June 2019 in “JEADV. Journal of the European Academy of Dermatology and Venereology/Journal of the European Academy of Dermatology and Venereology”

This study observed that abnormal hormone levels were associated with lower disease activity in frontal fibrosing alopecia, while thyroid disorders were a common comorbidity among the affected population.

research Frontal Fibrosing Alopecia: Just Lichen Planopilaris?

5 citations , April 2019 in “Journal of The American Academy of Dermatology”

This review discusses the complex nature of frontal fibrosing alopecia, suggesting it is a misnomer and possibly a subset of lichen planopilaris, but reports no new clinical results.

research Genome-Wide Association Study in Frontal Fibrosing Alopecia Identifies Four Susceptibility Loci Including HLA-B*07:02

115 citations , March 2019 in “Nature Communications”

This study identified significant genetic associations with frontal fibrosing alopecia at four genomic loci, suggesting it is a genetically predisposed immuno-inflammatory disorder influenced by the HLA-B*07: 02 allele.

research Frontal Fibrosing Alopecia: An Update on Pathogenesis, Diagnosis, and Treatment

61 citations , January 2019 in “American Journal of Clinical Dermatology”

This review discusses the potential causes and treatments for frontal fibrosing alopecia but reports no new clinical findings, highlighting the need for further research to understand its pathogenesis and develop validated treatments.

research Social Status May Interfere in the Prognosis of Frontal Fibrosing Alopecia in Female Patients: An Observational Study

2 citations , January 2019 in “Skin appendage disorders”

This study observed that women with higher educational levels and social status are diagnosed with frontal fibrosing alopecia earlier, resulting in better therapeutic responses.

research Frequency of the Types of Alopecia at Twenty-Two Specialist Hair Clinics: A Multicenter Study

56 citations , January 2019 in “Skin appendage disorders”

In this multicenter study, androgenetic alopecia was the most common type of alopecia among both men and women attending specialty hair clinics on four continents.

research Frontal Fibrosing Alopecia: A Case Series of 65 Patients Seen in a Single Italian Centre

23 citations , November 2018 in “Journal of the European Academy of Dermatology and Venereology”

This study observed that frontal fibrosing alopecia is increasingly diagnosed in Italian Caucasian females, often showing premenopausal onset and eyebrow alopecia as an early sign.

research Sunscreen and Facial Skincare Products in Frontal Fibrosing Alopecia: A Case-Control Study

26 citations , October 2018 in “British Journal of Dermatology”

This study found that high frequency use of sunscreen is associated with frontal fibrosing alopecia among women attending a specialist hair clinic in Australia.

research An Update of the Pathogenesis of Frontal Fibrosing Alopecia: What Does the Current Evidence Tell Us?

23 citations , October 2018 in “Australasian Journal of Dermatology”

This review highlights that frontal fibrosing alopecia’s increasing incidence may involve immune, genetic, hormonal, and environmental factors, yet its pathogenesis remains complex and not fully understood.

research The Value of Dermoscopy in Diagnosing Eyebrow Loss in Patients with Alopecia Areata and Frontal Fibrosing Alopecia

31 citations , October 2018 in “Journal of the European Academy of Dermatology and Venereology”

In this study, trichoscopic examination found distinct hair characteristics for diagnosing eyebrow loss: alopecia areata is marked by features like exclamation mark hairs, while frontal fibrosing alopecia shows dystrophic hairs and distinctive regrowth patterns.

research Frontal Fibrosing Alopecia and Cutaneous Comorbidities: A Potential Relationship with Rosacea

18 citations , February 2018 in “Journal of the American Academy of Dermatology”

This study reports no new clinical results but suggests a potential relationship between frontal fibrosing alopecia and cutaneous conditions such as rosacea, indicating a need for further research.

research Clinical Description of Frontal Fibrosing Alopecia with Concomitant Lichen Planopilaris

13 citations , September 2017 in “Skin appendage disorders”

Some women with Frontal Fibrosing Alopecia also have Lichen Planopilaris, which can lead to more symptoms and affect hair outside the scalp.

research Frontal Fibrosing Alopecia: Clinical and Prognostic Classification

74 citations , April 2017 in “JEADV. Journal of the European Academy of Dermatology and Venereology/Journal of the European Academy of Dermatology and Venereology”

This study classified frontal fibrosing alopecia patients into three clinical patterns, finding that pattern III had the best prognosis and pattern II the worst after treatment with dutasteride and corticosteroids.

research Update on Frontal Fibrosing Alopecia

2 citations , April 2017 in “Actas Dermo-Sifiliográficas”

This review discusses the etiology, pathogenesis, clinical presentation, and treatment of frontal fibrosing alopecia, noting the lack of clinical trial data and limited observational treatment results.

research Prevalence of Hormonal and Endocrine Dysfunction in Patients with Lichen Planopilaris: A Retrospective Data Analysis of 168 Patients

44 citations , February 2017 in “Journal of the American Academy of Dermatology”

This study found that postmenopausal women with lichen planopilaris showed a high prevalence of androgen excess, while women with frontal fibrosing alopecia were often associated with androgen deficiency.

research Frontal Fibrosing Alopecia and Lichen Planus Pigmentosus: Diagnosis and Therapeutic Challenge

16 citations , January 2017 in “Anais brasileiros de dermatologia/Anais Brasileiros de Dermatologia”

This case study discusses a postmenopausal woman's frontal fibrosing alopecia and lichen planus pigmentosus, controlled with corticosteroids and finasteride, highlighting diagnostic and therapeutic challenges in scarring alopecia.

research Frontal Fibrosing Alopecia: Reflections and Hypotheses on Etiology and Pathogenesis

68 citations , May 2016 in “Experimental dermatology”

This review discusses what is known about the pathobiology of frontal fibrosing alopecia and reports no new clinical findings, highlighting potential environmental and genetic factors in disease pathogenesis.

research It's Not All Traction: The Pseudo 'Fringe Sign' in Frontal Fibrosing Alopecia

39 citations , July 2015 in “British Journal of Dermatology”

This article discusses the pseudo 'fringe sign' in frontal fibrosing alopecia, highlighting that it is not solely related to traction, and it reports no new clinical results.

research Case Series of Familial Frontal Fibrosing Alopecia and a Review of the Literature

33 citations , January 2015 in “Journal of Cosmetic Dermatology”

This study reports that familial frontal fibrosing alopecia was diagnosed earlier in premenopausal women compared to postmenopausal women, though long-term outcomes remain uncertain without a definitive treatment.

research Trichoscopic Features of Frontal Fibrosing Alopecia: Results in 249 Patients

46 citations , January 2015 in “Journal of The American Academy of Dermatology”

This study suggests that trichoscopic features, such as perifollicular erythema and cicatricial white patches, are independently associated with pruritus and the severity of frontal fibrosing alopecia.

research Frontal Fibrosing Alopecia: A Retrospective Clinical Review of 62 Patients with Treatment Outcome and Long-Term Follow-Up

102 citations , April 2014 in “International Journal of Dermatology”

This study found that early intervention and treatment with intralesional triamcinolone acetonide may stabilize hairline recession in patients with frontal fibrosing alopecia, although further research is needed for definitive treatment guidelines.

Frontal Fibrosing Alopecia: A Multicenter Review of 355 Patients