Comment on: Risk Factors for Frontal Fibrosing Alopecia: A Case-Control Study in a Multiracial Population

The document is a commentary on a study by Müller Ramos et al. that investigated risk factors for frontal fibrosing alopecia (FFA) in a multiracial population. The commentary highlights that while the original study found an association between FFA and certain hair and facial skin care products, such as formalin-based hair straightening, non-dermatologic soap, and facial moisturizers, it did not find an association with sunscreens. The authors of the commentary express concern over the regional biases of questionnaire-based studies and the appropriateness of the control group used in the case-control study. They suggest that the control group choice is crucial and question whether androgenetic alopecia is suitable, given its different hair grooming practices and only being a facultative comorbidity in FFA. They also propose that FFA might represent a clinical presentation common to various underlying pathologies rather than a new disease entity. The commentary calls for future investigations to go beyond simplistic studies and consider evidence of causality, such as patient reactions to the removal and rechallenge of suspected agents, and to explore rational hypotheses regarding causal relationships. They cite studies on estrogen-like endocrine-disrupting chemicals and the detection of titanium in hair shafts of FFA patients as examples of more in-depth approaches to understanding the etiopathogenesis of FFA.