Clinicopathological Characteristics and Treatment Outcomes of Fibrosing Alopecia in a Pattern Distribution: A Retrospective Cohort Study

August 2021 in “ Journal of the European Academy of Dermatology and Venereology ”

Rebekka Jerjen, Joel Pinczewski, Rodney Sinclair, Bevin Bhoyrul

fibrosing alopecia lichen planopilaris FAPD hair shaft diameter variability perifollicular erythema perifollicular scaling loss of follicular ostia scarring alopecia interface changes corticosteroids 5α-reductase inhibitors hydroxychloroquine anti-inflammatory agents hair growth-promoting agents 5-alpha-reductase inhibitors Plaquenil

Studysummary This study suggests that early initiation of treatment in fibrosing alopecia in a pattern distribution may lead to a more favorable outcome, as evident in some patients experiencing arrested disease progression and hair regrowth. Our plain-language summary of this paper — not a Tressless recommendation.

The retrospective cohort study focused on 24 female patients with fibrosing alopecia in a pattern distribution (FAPD), a subtype of lichen planopilaris (LPP), with a mean age of 60.7 years and a median Sinclair grade of 3 for hair loss severity. Trichoscopic features included hair shaft diameter variability (100%), perifollicular erythema and/or scaling (95%), and loss of follicular ostia (95%). Histopathology showed scarring alopecia with interface changes. Treatments such as corticosteroids, 5α-reductase inhibitors, and hydroxychloroquine arrested disease progression in 14 patients and resulted in hair regrowth in 2 patients, but 6 patients experienced progression despite treatment. The study concluded that early treatment could lead to more favorable outcomes, though it acknowledged limitations such as small sample size and retrospective design. The study suggests that a combination of anti-inflammatory and hair growth-promoting agents may be beneficial, and emphasizes the need for early diagnosis and intervention.

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Research cited in this study

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research A Simple Technique to Distinguish Fibrosing Alopecia in a Pattern Distribution from Androgenetic Alopecia and Concomitant Seborrheic Dermatitis

2 citations , January 2021 in “Journal of The American Academy of Dermatology”

This pilot study found that examining changes in scalp scales after scraping may effectively distinguish seborrheic dermatitis associated with androgenetic alopecia from fibrosing alopecia in a pattern distribution.

research Female Pattern Hair Loss in Men: A Distinct Clinical Variant of Androgenetic Alopecia

5 citations , September 2020 in “Journal of The American Academy of Dermatology”

This study reported that low-dose oral minoxidil combined with a 5α-reductase inhibitor improved hair density in most men with female pattern hair loss after 6 months or more of treatment.

research Low-Dose Oral Minoxidil as Treatment for Non-Scarring Alopecia: A Systematic Review

19 citations , June 2020 in “International Journal of Dermatology”

In this systematic review, oral minoxidil was found to be a safe and effective treatment for androgenetic alopecia and alopecia areata, with additional benefits for female pattern hair loss and other types of alopecia, although common side effects included hypertrichosis and postural hypotension.

research Cicatricial Pattern Hair Loss Is Not a Variant of Lichen Planopilaris

4 citations , May 2020 in “Journal of The American Academy of Dermatology”

This letter argues that cicatricial pattern hair loss likely represents end-stage androgenetic alopecia and not a variant of lichen planopilaris, as previously suggested.

research Safety of Oral Bicalutamide in Female Pattern Hair Loss: A Retrospective Review of 316 Patients

16 citations , March 2020 in “Journal of The American Academy of Dermatology”

This abstract discusses the efficacy of spironolactone, cyproterone acetate, and flutamide in treating female pattern hair loss, noting that flutamide use requires caution due to potential liver toxicity, especially at high doses.

research Diffuse Variants of Scalp Lichen Planopilaris: Clinical, Trichoscopic, and Histopathologic Features of 40 Patients

35 citations , November 2019 in “Journal of the American Academy of Dermatology”

This study reviewed 40 patients with scalp symptoms and identified a new variant of diffuse lichen planopilaris in 20 individuals, suggesting these conditions should be considered in similar cases.

research Rapidly Progressive Diffuse Fibrosing Alopecia

5 citations , October 2019 in “JAAD Case Reports”

This case report describes a young man with rapidly progressive cicatricial alopecia that shows features overlapping several other types, suggesting these conditions may exist on a spectrum.

research Minoxidil 1 mg Oral Versus Minoxidil 5% Topical Solution for the Treatment of Female-Pattern Hair Loss: A Randomized Clinical Trial

53 citations , August 2019 in “Journal of The American Academy of Dermatology”

This study observed that low-dose oral minoxidil and topical minoxidil 5% solution both improved hair density in women with female-pattern hair loss, but oral minoxidil may offer advantages in reducing hair shedding.

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 Effectiveness and Safety of Low-Dose Oral Minoxidil in Male Androgenetic Alopecia

52 citations , May 2019 in “Journal of The American Academy of Dermatology”

This study evaluated the effectiveness and safety of low-dose oral minoxidil (2.5-5 mg daily) in men with male androgenetic alopecia, aiming to contribute data to an area with limited previous reports. Results are not provided in the abstract.

research Fibrosing Alopecia in a Pattern Distribution in 16 African-Descent and Hispanic Female Patients: A Challenging Diagnosis

13 citations , January 2019 in “Skin appendage disorders”

This study reported that fibrosing alopecia in a pattern distribution can occur in patients of color, with clinical and histopathological features allowing for an accurate differential diagnosis.

research Tofacitinib for the Treatment of Lichen Planopilaris: A Case Series

79 citations , September 2018 in “Dermatologic therapy”

This study found that treatment with oral tofacitinib, alone or with other therapies, was associated with clinical improvement in most patients with recalcitrant lichen planopilaris.

research Lichen Planopilaris and Frontal Fibrosing Alopecia as Model Epithelial Stem Cell Diseases

80 citations , April 2018 in “Trends in Molecular Medicine”

This review discusses the roles of interferon-γ and PPAR-γ-mediated signalling in scarring alopecia, suggesting these pathways as potential therapeutic targets, but it reports no new empirical results.

research Clinical Study of Fibrosing Alopecia in a Pattern Distribution in a Latin American Population

13 citations , January 2018 in “International Journal of Dermatology”

This clinical study on fibrosing alopecia in a pattern distribution among a Latin American population reports no new results but addresses this specific condition in its demographic context.

research Female Pattern Hair Loss: A Pilot Study Investigating Combination Therapy with Low-Dose Oral Minoxidil and Spironolactone

80 citations , December 2017 in “International Journal of Dermatology”

This study reported that once-daily treatment with oral minoxidil and spironolactone for 12 months reduced hair loss severity and hair shedding in women with pattern hair loss, with generally mild side effects, though results came from an uncontrolled, observational pilot study.

research Red Dots in a Net-Like Pattern on the Upper Chest: A Novel Clinical Observation in Frontal Fibrosing Alopecia and Fibrosing Alopecia in Pattern Distribution

8 citations , August 2017 in “Skin appendage disorders”

Red dots on the upper chest may be an early sign of certain types of hair loss.

research A New Subtype of Lichen Planopilaris Affecting Vellus Hairs and Clinically Mimicking Androgenetic Alopecia

9 citations , September 2016 in “Dermatologic Surgery”

This study identified a new subtype of lichen planopilaris that mimics androgenetic alopecia, selectively affecting vellus hair follicles and presenting unique histopathological features.

research Dermatoscopic Features of Central Centrifugal Cicatricial Alopecia

64 citations , June 2014 in “Journal of The American Academy of Dermatology”

This study found that a peripilar white gray halo around hair emergence is a highly specific and sensitive dermatoscopic feature for diagnosing central centrifugal cicatricial alopecia in African American patients with mild central thinning.

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 Lichen Planopilaris Is Characterized By Immune Privilege Collapse Of The Hair Follicle's Epithelial Stem Cell Niche

220 citations , June 2013 in “The Journal of Pathology”

This study found that immune privilege collapse in the hair follicle bulge and associated immune responses may contribute significantly to the pathogenesis of lichen planopilaris, suggesting a potential autoimmune basis for the disease.

research Fibrosing Alopecia in a Pattern Distribution

16 citations , February 2010 in “Journal of the European Academy of Dermatology and Venereology”

This article is a letter to the editor about fibrosing alopecia in a pattern distribution and reports no new research findings.

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170 citations , December 2009 in “Histopathology”

This review discusses the histopathological diagnosis of scarring and non-scarring alopecias, emphasizing the importance of adequate tissue sampling and clinical information; it reports no new empirical results.

research Cicatricial Alopecia: Classification and Histopathology

74 citations , July 2008 in “Dermatologic therapy”

This review discusses histopathologic findings in diagnosing primary cicatricial alopecias and emphasizes the importance of correlating histology with clinical presentation for accurate diagnosis; it reports no new results.

research Female Pattern Hair Loss and Its Relationship to Permanent/Cicatricial Alopecia: A New Perspective

73 citations , November 2005 in “Journal of Investigative Dermatology Symposium Proceedings”

This article reviews the potential relationship between different forms of permanent hair loss such as cicatricial pattern hair loss and discusses related conditions, reporting no new clinical findings.

research The Reliability of Horizontally Sectioned Scalp Biopsies in the Diagnosis of Chronic Diffuse Telogen Hair Loss in Women

137 citations , July 2004 in “Journal of The American Academy of Dermatology”

This study observed that triple horizontal scalp biopsies provided a more accurate diagnosis of female pattern hair loss in women than a single horizontal biopsy, especially for those with advanced hair loss.

research Fibrosing Alopecia in a Pattern Distribution

158 citations , February 2000 in “Archives of dermatology”

This study reports that some patients with androgenetic alopecia may also exhibit clinical and histological features of inflammation and fibrosis, similar to those found in lichen planopilaris.

research Postmenopausal Frontal Fibrosing Alopecia

325 citations , June 1994 in “Archives of Dermatology”

This study observed that progressive frontal recession in postmenopausal women may exhibit features of fibrosing alopecia, suggesting a distinct reaction pattern from typical lichen planopilaris.

research Diagnostic and Predictive Value of Horizontal Sections of Scalp Biopsy Specimens in Male Pattern Androgenetic Alopecia

309 citations , May 1993 in “Journal of The American Academy of Dermatology”

This study concluded that horizontal sections of scalp biopsy specimens provide more diagnostic information for male pattern androgenetic alopecia than vertical sections and can predict hair regrowth potential following topical minoxidil therapy.

research Hot Comb Alopecia

107 citations , September 1968 in “Archives of Dermatology”

In this study, researchers identified a form of irreversible scalp alopecia in Black women using hot combs, characterized by incomplete hair loss primarily on the crown and follicular scarring.