Frontal Fibrosing Alopecia: Iatrogenic Endocrine Disruption

The document presents a study on Frontal fibrosing alopecia (FFA), a condition characterized by scarring hair loss in the frontal hairline, primarily affecting white, menopausal women. The study, conducted from 2011 to 2014, involved 23 women with FFA and aimed to explore the potential iatrogenic endocrine disruption caused by drugs and supplements that target cholesterol and the gut microbiome. The researchers hypothesized that these substances could compromise nuclear receptors that protect the endocrine system, with off-target effects manifesting in sex steroid-dependent tissues like the frontal hairline. The study found that 87% of participants were Fitzpatrick skin types I and II, 61% had a BMI over 25, and a significant proportion were taking medications known to negatively impact insulin resistance or were consuming multiple supplements. Adjustments in medications led to 9 patients responding with reduced redness and scale at the follicular os and no further progression of alopecia. One patient responded to increased vitamin D, while another with a history of premature ovarian failure did not respond to any treatment. The study concluded that FFA may result from inflammatory attacks on hair follicles, influenced by changes in aromatase behavior due to age and menopause, and that the use of certain drugs and supplements warrants further investigation.