The Increasing Incidence of Frontal Fibrosing Alopecia: In Search of Triggering Factors

The commentary from 2017 discusses the increasing incidence of frontal fibrosing alopecia (FFA) and explores potential triggering factors. Moreno-Arrones et al. identified three patterns of hair loss associated with FFA, and other presentations have also been described. The disease course can vary, with factors like the diffuse zigzag pattern, madarosis, facial papules, and body hair involvement linked to more severe and rapid hair loss. Despite the lack of epidemiological data, there is a consensus on the rise in FFA cases seeking dermatological care. Hormonal dysfunctions, particularly in perimenopausal women, have been suggested as pathogenic factors, but these have not significantly changed in the general population to account for the increased prevalence. Environmental factors such as exposure to computer screens, shampoos, sunscreens, hair dyes, oral contraceptives, and facial hair removal have been considered, with sunscreen use being a debated trigger. Smoking may have a protective effect, although this requires further confirmation. A pilot study comparing dietary habits of 59 women with FFA and 59 healthy controls found significant differences in the consumption of buckwheat and millet groats, but the etiopathogenetic role of these factors remains uncertain. The commentary concludes that various triggering factors may contribute to the development of FFA and its rising incidence, emphasizing the need to identify and avoid potential environmental triggers to halt the disease's progression and epidemic spread.