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

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

Alexander C. Katoulis, K. Diamanti, Dimitrios Sgouros, Aikaterini I. Liakou, E. Bozi, Georgia Avgerinou, Ioannis Panayiotides, Dimitrios Rigopoulos

frontal fibrosing alopecia androgenetic alopecia fibrosing alopecia lichenoid reaction follicular destruction androgen-related antigenic stimulus immunogenetically susceptible scarring variant FFA AGA FAPD

Studysummary 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.

Our plain-language summary. Not medical advice or a treatment recommendation. Consult a qualified healthcare professional before changing treatment. Full disclaimer

The authors of this letter to the editor report on the frequent coexistence of frontal fibrosing alopecia (FFA) and androgenetic alopecia (AGA) in women, and suggest that these conditions might be pathogenetically related. They conducted a study of 35 female patients diagnosed with FFA, and found that 57% of them also had AGA. They suggest that the lichenoid reaction leading to follicular destruction in patients with FFA might be pathogenetically related to the events underlying AGA, and that an androgen-related antigenic stimulus may initiate a lichenoid reaction in an immunogenetically susceptible individual. They also discuss the overlap of FFA, AGA, and fibrosing alopecia in a pattern distribution (FAPD) in some patients, and suggest that FFA could represent a scarring variant of AGA.

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Research cited in this study

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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 Female Pattern Hair Loss: A Review Article

57 citations , October 2013 in “international journal of endocrinology and metabolism”

This review discusses clinical features, differential diagnosis, and treatments for female pattern hair loss, emphasizing the use of 2% topical Minoxidil and exploring alternative off-label therapies.

research Treatment of Postmenopausal Frontal Fibrosing Alopecia with Oral Dutasteride

64 citations , June 2009 in “Journal of The American Academy of Dermatology”

This article discusses frontal fibrosing alopecia, noting potential connections to lichen planopilaris, but reports no new clinical findings.

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 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 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.