Clinical-histopathological profile of the frontal fibrosing alopecia: a retrospective study of 16 cases of a university hospital

Abstract

Background: Frontal fibrosing alopecia is a condition of unknown origin, histologically similar to classic lichen planopilaris and generally observed in postmenopausal women with alopecia of the frontal-temporal hairline. oBjectives: To describe the clinical, dermatoscopic, and histopathological characteristics and the treatment used in patients who have frontal fibrosing alopecia at the Alopecia Outpatient Clinic in a university hospital. Methods: Retrospective descriptive study performed by reviewing medical charts and biopsies of the scalp. results: Sixteen patients were analyzed, all of them female, 93.75% of them postmenopausal, and 56.25% brown-skinned. All had frontal alopecia (100%), followed by temporal alopecia (87.5%) and madarosis (87.5%). On dermatoscopy, perifollicular erythema and tubular scales were found as a sign of disease activity. Of the patients, 68.75% had associated autoimmune diseases, including lupus, thyroid disease and vitiligo. Of the 13 biopsies from 8 patients, 10 showed microscopic aspects compatible with frontal fibrosing alopecia. Laboratory tests did not show major abnormalities and minoxidil was the most used treatment. study liMitation: Data collection limited by the study's retrospective design associated to flaws while filling in the medical charts and absence in standards to the collection and processing of the pathology and histopathological examination. conclusions: A demographical, clinical, and histopathological description of 16 patients diagnosed with frontal fibrosing alopecia, which remains a challenging disease, of unknown origin, and frequently associated with autoimmune diseases. This study reinforces literary findings. However, more research is needed to establish the pathogenesis and effective treatments.

Clinical Characteristics of Frontal Fibrosing Alopecia in Brazil: A Series of 59 Patients

“…When comparing present data with the literature, we observed a balanced division between Caucasians and Afro--descendants (p>0.05), which should reflect the great miscegenation of our population, as it can be seen in another Brazilian study. 17 Our data reflects a slightly earlier age of onset of FFA (52y) compared to the literature. 4,18 As in previous studies, most patients are postmenopausal, but unlike these, the prevalence of women under hormone replacement therapy is lower (28.6%) compared some reports.…”

“…As for comorbidities, hypothyroidism was common among patients with FFA, with a lower prevalence than in other studies, 4,19 but similar to Brazilian studies. 17,21 In the authors experience, patients who were treated for FFA with doxycycline, hydroxychloroquine or finasteride had a slightly better control of the symptoms and clinical signs, such as positive pull test and pruritus, but progression seems to have its natural way and is limited to the natural history of the disease, which is still unknown. 7 Loss of body hair did not seem to be reversed or affected by treatment.…”

“…Others, like FFA type two and patients with other autoimmune diseases, such as lupus erythematosus, polymyositis and autoimmune hepatitis, seem to have a more aggressive behaviour. We used hydroxychloroquine and 5-alpha-reductase inhibitors similarly to Chileans18 and Secchin in Brazil, 17 but the former less frequently and the latter more frequently than reported in Valesky et al, 4 and Kusano in Brazil. 21 In our series, the use of topical corticosteroids and intralesional infiltration of corticosteroids was lower as compared with most other studies.…”

Evaluation of the Demographic Characteristics and the Factors Related to Eyebrow Involvement in Frontal Fibrosing Alopecia: A Retrospective, Cross-sectional, Single Center Study

“…Similar to ours, a previous study by Secchin et al also reported an exclusively female patient population. 5 Zhang et al reported a population composed of 97% females, Kanti et al of 95% females, and Maldonado Cid et al of 97% females. 3,6,7 Recently, a case series of 7 male FFA patients has also been published; however, male patients are still a minority.…”

“…8 The result of this study in terms of gender distribution is in alliance with the previous literature: FFA is a disease that predominantly affects females. 3,[5][6][7] The increased prevalence of FFA in women especially in the postmenopausal period suggests the hormonal factors in disease pathogenesis. The role of sex hormones is not proven yet, while some studies found no correlation between sex hormones and FFA disease activity, in some studies, abnormal testosterone and estrogen values were found to be associated with lesser disease activity, and in a recent paper demonstrating that the serum levels of dehydroepiandrosterone sulfate (DHEAS) and an- drostenedione were significantly lower in FFA patients compared to healthy controls.…”