Clinical Characteristics, Trichoscopy, Histopathology, and Treatment Outcomes of Frontal Fibrosing Alopecia in an Asian Population: A Retro-Prospective Cohort Study

July 2020 in “ Journal of Dermatology ”

Ratchathorn Panchaprateep, Pariya Ruxrungtham, Bussabong Chancheewa, Pravit Asawanonda

frontal fibrosing alopecia FFA eyebrow loss facial papules follicular ostia trichoscopic examination histopathological examination perifollicular fibrosis lymphocytic infiltration antiandrogens antimalarials topical treatments hair trauma facial lentiginous macules trichoscopic perifollicular erythema eyebrow tattooing

Studysummary This study found that diffuse and pseudo-fringe sign patterns are common in Asian patients with frontal fibrosing alopecia, and that treatments combining antiandrogens or antimalarials with topical therapy are effective. Our plain-language summary of this paper — not a Tressless recommendation.

In a retro-prospective cohort study of 58 Asian female patients with Frontal Fibrosing Alopecia (FFA), researchers found that 69% experienced eyebrow loss, 32.8% had facial papules, and 91.4% showed a lack of follicular ostia on trichoscopic examination. Histopathological examination in 14 patients commonly revealed perifollicular fibrosis (92.9%) and lymphocytic infiltration (78.6%). The study concluded that antiandrogens or antimalarials combined with topical treatments were effective, with up to 90% of patients seeing improvement or stabilization. The "Front puff" Thai hairstyle was associated with FFA, suggesting hair trauma from repeated pulling as a potential factor. Facial lentiginous macules and trichoscopic perifollicular erythema were identified as factors associated with FFA severity. The study highlighted differences in FFA symptoms and clinical features among different ethnic groups and noted that eyebrow tattooing in Thailand may obscure the recognition of eyebrow hair loss. Despite its insights, the study had limitations such as a small sample size and potential for recall bias.

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research Fibrosing Alopecia in a Pattern Distribution

30 citations , January 2020 in “Journal of The American Academy of Dermatology”

This review reports no new clinical results but discusses fibrosing alopecia in a pattern distribution as a distinct scarring alopecia with characteristics of both androgenetic alopecia and lichen planopilaris.

research Frontal Fibrosing Alopecia in Asians: A Retrospective Clinical Study

8 citations , October 2019 in “International Journal of Dermatology”

This study examined 56 Thai patients with frontal fibrosing alopecia, finding frontotemporal hairline recession and eyebrow loss were common, and reported better disease stabilization with combination treatments of topical corticosteroids with hydroxychloroquine or finasteride.

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: An Update on the Hypothesis of Pathogenesis and Treatment

38 citations , January 2019 in “International Journal of Women's Dermatology”

This review discusses potential therapeutic options for frontal fibrosing alopecia by exploring distinct signaling pathways and cellular players, but reports no new clinical findings and emphasizes the need for further trials.

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 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.

Facial and Extrafacial Lesions in an Ethnically Diverse Series of 91 Patients with Frontal Fibrosing Alopecia Followed at a Single Center

research Facial and Extrafacial Lesions in an Ethnically Diverse Series of 91 Patients with Frontal Fibrosing Alopecia Followed at a Single Center

17 citations , November 2018 in “Dermatology”

The authors concluded that Hispanic/Latino ethnicity, facial papules, and premenopausal status in patients with frontal fibrosing alopecia may indicate a susceptibility to more severe disease, potentially necessitating early treatment.

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.

Is There a Pathogenetic Link Between Frontal Fibrosing Alopecia, Androgenetic Alopecia, and Fibrosing Alopecia in a Pattern Distribution?

research Is There a Pathogenetic Link Between Frontal Fibrosing Alopecia, Androgenetic Alopecia, and Fibrosing Alopecia in a Pattern Distribution?

15 citations , December 2017 in “Journal of The European Academy of Dermatology and Venereology”

This letter discusses potential pathogenetic links among frontal fibrosing alopecia, androgenetic alopecia, and fibrosing alopecia in a pattern distribution and reports no new clinical findings.

research Frontal Fibrosing Alopecia Among Men: A Clinicopathologic Study of 7 Cases

41 citations , July 2017 in “Journal of The American Academy of Dermatology”

This study observed that frontal fibrosing alopecia also occurs in men, with clinical features and areas of involvement similar to those seen in women, but often affecting sideburns and facial hair.

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 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 DHEA and Frontal Fibrosing Alopecia: Molecular and Physiopathological Mechanisms

31 citations , December 2016 in “Anais Brasileiros de Dermatologia”

This review discusses the fibrogenic effects of TGFβ1, the regulatory role of PPAR, and the potential involvement of DHEA in frontal fibrosing alopecia, but reports no new clinical results.

research Frontal Fibrosing Alopecia in Men: Presentation of 12 Cases and Literature Review

26 citations , August 2016 in “Actas Dermo-Sifiliográficas”

This study found that men with frontal fibrosing alopecia were more likely to have facial papules, androgenetic alopecia, and body hair loss compared to women, with the average patient age being higher than in other series, potentially explaining these differences.

research Frontal Fibrosing Alopecia: Report of Three Pediatric Cases

17 citations , June 2016 in “Archives de Pédiatrie”

This case report describes three pediatric cases of frontal fibrosing alopecia, a condition typically seen in postmenopausal women, including a unique instance involving female twins.

research Clinical and Dermoscopic Features of Lichen Planus Pigmentosus in 37 Patients with Frontal Fibrosing Alopecia

62 citations , May 2016 in “British journal of dermatology/British journal of dermatology, Supplement”

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 Frontal Fibrosing Alopecia in a 46-Year-Old Man

2 citations , January 2016 in “Dermatology online journal”

This case report describes a 46-year-old man diagnosed with frontal fibrosing alopecia, a condition primarily affecting postmenopausal women, highlighting its rare occurrence in men.

research Classifications of Patterned Hair Loss: A Review

101 citations , January 2016 in “Journal of Cutaneous and Aesthetic Surgery”

This review discusses various classification systems for patterned hair loss in both sexes and reports no new clinical findings, highlighting the Hamilton-Norwood and Ludwig systems as the most commonly used.

research Towards a Consensus on How to Diagnose and Quantify Female Pattern Hair Loss – The Female Pattern Hair Loss Severity Index (FPHL-SI)

26 citations , December 2015 in “Journal of The European Academy of Dermatology and Venereology”

This article introduces a new grading system called the FPHL Severity Index to better identify and monitor early stages of female pattern hair loss using clinical criteria.

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 Frontal Fibrosing Alopecia: A Multicenter Review of 355 Patients

339 citations , February 2014 in “Journal of The American Academy of Dermatology”

This study found that eyelash loss, facial papules, and body hair involvement were linked to severe frontal fibrosing alopecia, and antiandrogens were the most effective treatment.

research Frontal Fibrosing Alopecia in an African Man

13 citations , August 2013 in “International Journal of Dermatology”

Frontal fibrosing alopecia can affect African men and may be underdiagnosed.

research Frontal Fibrosing Alopecia: A Retrospective Review of 19 Patients Seen at Duke University

98 citations , January 2013 in “Journal of The American Academy of Dermatology”

This study reported that while various treatments for frontal fibrosing alopecia showed limited effectiveness, dutasteride most effectively stabilized the condition among patients at Duke University.

research Frontal Fibrosing Alopecia and Lichen Planus Pigmentosus: Is There a Link?

86 citations , July 2012 in “British journal of dermatology/British journal of dermatology, Supplement”

This report suggests a causal connection between hyaluronic acid filler injections and the development of xanthelasma, possibly through an inflammatory reaction that increases vascular permeability and LDL leakage.

research Estrogen Leads to Reversible Hair Cycle Retardation Through Inducing Premature Catagen and Maintaining Telogen

42 citations , July 2012 in “PLOS ONE”

This study found that estrogen can cause reversible suppression of the hair cycle by inducing premature catagen and maintaining the telogen phase without damaging the hair follicle stem cell niche or the signature gene expressions of dermal papilla cells.

research Frontal Fibrosing Alopecia: A Review of 60 Cases

166 citations , April 2012 in “Journal of The American Academy of Dermatology”

This study reviewed clinical data from 60 patients with frontal fibrosing alopecia and found increasing prevalence and generally poor response to treatment, with the cause remaining unclear.

research Frontal Fibrosing Alopecia: A Clinical Review of 36 Patients

159 citations , August 2010 in “British journal of dermatology/British journal of dermatology, Supplement”

In this study, hydroxychloroquine significantly reduced signs and symptoms of frontal fibrosing alopecia after 6 months of treatment, with maximal benefits observed within the first 6 months.

research Frontal Fibrosing Alopecia: Clinical Presentations and Prognosis

155 citations , September 2008 in “British journal of dermatology/British journal of dermatology, Supplement”

This study observed that frontal fibrosing alopecia predominantly affects postmenopausal women, can be associated with lichen planus, and may lead to progressive hairline recession, though this progression is not consistent in all cases.

research Frontal Fibrosing Alopecia: Diagnostic and Therapeutic Assessment

54 citations , November 2007 in “Actas Dermo-Sifiliográficas”

Early diagnosis of frontal fibrosing alopecia is crucial to prevent permanent hair loss.

research Frontal Fibrosing Alopecia Versus Lichen Planopilaris: A Clinicopathological Study

126 citations , April 2006 in “International Journal of Dermatology”

This study found that frontal fibrosing alopecia and lichen planopilaris have similar histopathological features, but FFA exhibits more prominent apoptosis and less inflammation with spared interfollicular epidermis.

research Frontal Fibrosing Alopecia: A Survey in 16 Patients

123 citations , August 2005 in “Journal of the European Academy of Dermatology and Venereology”

In this study, the researchers observed that treatment with intralesional and topical corticosteroids, finasteride, and minoxidil may stop the progression of frontal fibrosing alopecia in postmenopausal and premenopausal women.

research Frontal Fibrosing Alopecia in Postmenopausal Women

179 citations , December 2004 in “Journal of The American Academy of Dermatology”

This study observed that frontal fibrosing alopecia in postmenopausal women involves selective follicular inflammation, and finasteride treatment may slow disease progression, suggesting a potential androgen-related component.

research Postmenopausal Frontal Fibrosing Alopecia: A Frontal Variant of Lichen Planopilaris

329 citations , January 1997 in “Journal of the American Academy of Dermatology”

This study reports that progressive frontal fibrosing alopecia, a distinct and gradually stabilizing form of lichen planopilaris affecting elderly women and often involving eyebrow hair loss, lacks effective treatments.