A Case of Frontal Fibrosing Alopecia in a Patient with Primary Biliary Cirrhosis and Polymyalgia Rheumatica

Eginli, Ariana; Bagayoko, Courtney W.; McMichael, Amy J.

doi:10.1159/000447493

Cited by 5 publications

(5 citation statements)

References 20 publications

(35 reference statements)

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“…We found a strong association between FFA and LPP, which were associated in almost 1/4 of the patients, suggesting that FFA represents a clinical variant of LPP, with an autoimmune pathogenesis. According to literature, 3,[12][13][14][15][16][17] we found a significant prevalence of other autoimmune diseases (50.8%) in our patients and a high percentage of patients with atopic background (35.4%), suggesting a possible personal predisposition to immune system disorders.…”

Section: Discussionsupporting

confidence: 65%

Frontal fibrosing alopecia: a case series of 65 patients seen in a single Italian centre

Starace

Brandi

Alessandrini

et al. 2018

Acad Dermatol Venereol

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Background Frontal fibrosing alopecia (FFA) is increasing in prevalence worldwide and several series from different countries have been published, in order to detect possible causes of the disease outbreak. Objective To analyze the epidemiological, clinical and trichoscopic features of FFA seen in an Italian Dermatology Unit. Methods Clinical, trichoscopy, histopathology and medical details of all patients were compared with literature and general population data. Results From 2005 to 2017, we diagnosed FFA in 65 Caucasian females, with the number of diagnoses per year progressively rising. Premenopausal onset was detected in 21%. Frontal hair line recession was associated with parietal involvement in 80% of cases, occipital in 12.3% and eyebrows alopecia in 86.1%. In six cases, eyebrow alopecia preceded hair loss. Non‐inflammatory facial papules were detected in 1/3 of the patients. Itching was reported by 2/3 of the patients and was indicative of disease progression. Trichoscopy showed empty follicles/yellow dots, absence of follicular ostia, mild follicular hyperkeratosis, perifollicular erythema and ‘lonely hair’. Scalp lichen plano‐pilaris was seen in 15 patients, female pattern hair loss in 22. Therapy included short‐term treatment with systemic or intralesional corticosteroids followed by therapy with 5α‐reductase inhibitors of hydroxychloroquine and topical drugs. Arrest of FFA progression was seen in 75% of the patients, while 16 experienced worsening of the hairline despite therapy. Conclusions Frontal fibrosing alopecia not rarely starts before menopause, loss of the eyebrows can be the first sign of the disease, about 50% of the patients have other autoimmune conditions, FFA severity is not related to its duration, itching, follicular hyperkeratosis and erythema at trichoscopy are signs of disease progression, 25% of the patients show progression of hairline recession despite therapy.

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Section: Discussionsupporting

confidence: 65%

Frontal fibrosing alopecia: a case series of 65 patients seen in a single Italian centre

Starace

Brandi

Alessandrini

et al. 2018

Acad Dermatol Venereol

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“…Numerous associations of cutaneous and systemic diseases with FFA have been reported previously, including, among others, rheumatoid arthritis, vitiligo, Sjogren's syndrome, systemic and discoid lupus erythematosus, pemphigoid, alopecia areata, Crohn's disease, psoriasis and multiple sclerosis . Coexisting of autoimmune and immune‐mediated diseases in the same individuals is not rare . A reported association of FFA with rosacea could not be confirmed in this sample, as the observed prevalence of rosacea was lower than in the general population .…”

Section: Discussionmentioning

confidence: 55%

Frontal fibrosing alopecia: demographic and clinical characteristics of 490 cases

Kanti

Constantinou

Reygagne

et al. 2019

Acad Dermatol Venereol

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Background Frontal fibrosing alopecia (FFA) is a cicatricial alopecia mostly affecting the frontotemporal hairline. Its aetiology and associated factors remain unclear.Objective and methods An observational, cross-sectional and descriptive study was conducted in France and Germany to identify demographic and health characteristics associated with the severity of FFA. ResultsOf 490 included patients, 95% were female, of which 84% were postmenopausal. Age at onset of FFA symptoms ranged between 15 and 89 years, but diagnosis was frequently delayed up to 24 years. Lichen Planopilaris Activity Index scores were low (median 1.8, IQR 1.0 to 3.5). Thyroid function disorders were reported in 13% of men and 35% of women. Abnormal blood lipid levels were found in 42% of tested men and 47% of women. In the bivariate analyses, LPPAI scores were negatively correlated with abnormal testosterone (r s = À0.775) and oestrogen values (r s = À0.664), regular use of face cleaning products (r s = À0.465), hair colourants (r s = À0.679) and hairspray (r s = À0.500).Conclusions The most common comorbidity was thyroid disease, with proportions higher than in the European population, possibly reflecting a role of thyroid hormones in FFA pathogenesis. The association of abnormal testosterone and oestrogen values with lesser disease activity needs to be explored in further studies. Our correlation analyses do not support a role of leave-on cosmetic products in the pathophysiology of FFA.

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“…About 9.7% to 30% FFA patients, mostly women, have an associated immune disorder [ 13 , 55 ]; the most frequent are thyroid diseases, especially hypothyroidism (8–44.6%) [ 3 , 13 , 14 , 56 ]. Other autoimmune conditions, which have been described together with FFA, are referred to in Table 1 [ 3 , 13 , 14 , 56 , 57 , 58 , 59 , 60 ]. Several studies have demonstrated that patients with FFA are significantly more likely to have systemic lupus erythematosus, while patients with LPP and FFA are less likely to have diabetes [ 61 , 62 ].…”

Section: Aetiopathogenesismentioning

confidence: 99%

Frontal Fibrosing Alopecia: A Review

Porriño‐Bustamante

Fernández‐Pugnaire

Arias‐Santiago

2021

JCM

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Frontal fibrosing alopecia is a scarring alopecia, the prevalence of which is increasing worldwide since its first description in 1994. The reason for this emerging epidemic may be a higher exposure to an unknown trigger, although its aethiology and pathogenesis still remain enigmatic. Clinical, trichoscopic, sonographic, and histopathologic findings are allowing clinicians to understand more aspects about this type of cicatricial alopecia. Several treatments have been used in frontal fibrosing alopecia, although the 5-alpha reductase inhibitors seem to be the most promising. The aim of this report is to provide a compilation about the published data regarding frontal fibrosing alopecia in a narrative review.

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A Case of Frontal Fibrosing Alopecia in a Patient with Primary Biliary Cirrhosis and Polymyalgia Rheumatica

Cited by 5 publications

References 20 publications

Frontal fibrosing alopecia: a case series of 65 patients seen in a single Italian centre

Frontal fibrosing alopecia: a case series of 65 patients seen in a single Italian centre

Frontal fibrosing alopecia: demographic and clinical characteristics of 490 cases

Frontal Fibrosing Alopecia: A Review

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