Fibrosing alopecia in a pattern distribution

Griggs, Jacob; Trüeb, Ralph M.; Dias, Maria Fernanda Reis Gavazzoni; Hordinsky, Maria; Tosti, Antonella

doi:10.1016/j.jaad.2019.12.056

Cited by 44 publications

(144 citation statements)

References 32 publications

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“…FAPD is a newly recognized form of scarring alopecia sharing characteristics of both AGA and LPP 44 . Scalp biopsy is necessary to confirm the diagnosis with the histopathology of lymphohistiocytic infiltrate around the isthmus and infundibular regions with a focal interface invading into the outer root sheath and hair follicle miniaturization 45 . In cases where hair transplantation is being considered, FAPD patients are not good candidates due to the risk of Koebnerization and loss of the transplanted hair.…”

Section: Discussionmentioning

confidence: 99%

Clinical characteristics, trichoscopy, histopathology and treatment outcomes of frontal fibrosing alopecia in an Asian population: A retro‐prospective cohort study

Panchaprateep

Ruxrungtham

Chancheewa

et al. 2020

The Journal of Dermatology

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Frontal fibrosing alopecia (FFA) is a distinctive lymphocytic scarring alopecia with rapid increase in prevalence. Most FFA series are retrospectively reported from Caucasians with only few from Asians. The objective of this study was to characterize the clinical, trichoscopic and histopathological findings as well as treatment outcomes. This was a retro‐prospective cohort study of patients diagnosed with FFA from 1 January 2010 to 1 November 2019. All patients were asked to present for re‐examination. Clinical, trichoscopic, histopathological and laboratory data were recorded. A questionnaire was used to investigate hair care, hairstyle and facial skin care compared with age‐matched normal controls. Multivariate analysis was performed in order to clarify factors associated with severity. All 58 FFA patients were female, of whom 27.6% were premenopausal, 37.7% had a history of surgical menopause, 13.8% had thyroid diseases, 69% had eyebrow loss and 32.8% facial papules. On physical examination, 10.3% showed linear pattern, 46.6% diffuse pattern and 43.1% pseudo‐fringe sign. Concomitant lichen planopilaris was found in 25.9%, lichen planus pigmentosus in 24.1% and female pattern hair loss in 48.3%. The most common trichoscopic characteristics in the frontal hairline were lack of follicular ostia (91.4%), perifollicular scales (79.3%) and perifollicular erythema (63.8%). Up to 90% of patients reported FFA as improved or stable after receiving antiandrogen (finasteride or dutasteride) or antimalarial with topical treatment. Multivariate analyses revealed that facial lentiginous macules and trichoscopic perifollicular erythema at the frontal area were FFA severity‐associated factors. “Front puff” Thai hairstyle was associated with FFA, while sunscreens and other cosmetic products were not. In conclusion, diffuse and pseudo‐fringe sign pattern are common in Asian FFA. The most common autoimmune systemic comorbidity is thyroid disease, while common concomitant dermatological diseases are female pattern hair loss, lichen planopilaris and lichen planus pigmentosus. Antiandrogens or antimalarial plus topical treatment are the most useful therapy.

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Section: Discussionmentioning

confidence: 99%

Clinical characteristics, trichoscopy, histopathology and treatment outcomes of frontal fibrosing alopecia in an Asian population: A retro‐prospective cohort study

Panchaprateep

Ruxrungtham

Chancheewa

et al. 2020

The Journal of Dermatology

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“…It is characterized by a combination of clinical, trichoscopic and histopathological features of both lichen planopilaris (LPP) and androgenetic alopecia (AGA). 1,[2][3][4][5][6][7][8][9][10][11] FAPD may also coexist with frontal fibrosing alopecia (FFA). 2 AGA is the most common form of non-scarring alopecia, caused by hair thinning on androgen dependent scalp.…”

Section: Introductionmentioning

confidence: 99%

“…Unlike AGA, we find many focal areas of cicatricial alopecia, peripilar erythema and peripilar hyperkeratosis in trichoscopy and lichenoid inflammation in histopathology. 1,2,[6][7][8][9] It has been first described in Caucasians but may also affect Hispanics and African-descents. 2,6,9 It is more common in women, most often in post-menopause or peri-menopause.…”

Section: Introductionmentioning

confidence: 99%

Alopecia Fibrosante em Padrão de Distribuição Androgenética: Patogénese, Diagnóstico e Tratamento

Marcos-Pinto

Caprio

Soares

2020

SPDV

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Fibrosing alopecia in a pattern distribution is a recently recognized type of scarring alopecia, with hair loss in androgens- dependent area. Loss of follicular openings, perifollicular erythema, perifollicular hyperkeratosis and anisotriquia are the trichoscopic clues and follicular lichenoid inflammatory infiltrate the important finding in histopathology. It shares features of androgenetic alopecia and lichen planopilaris. Dermatologists should be familiarized with this entity in order to optimize the diagnosis and provide early treatment to prevent irreversible follicular damage.

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“…This may include drug reactions, viral hepatitis, cutaneous GvHD, and ultimately PHL in FAPD. Ultimately, Olsen [5] approved the existence of cicatricial PHL, while more recently, others [6][7][8] have acknowledged that FAPD earns its own entity due to its lichenoid inflammation exclusively affecting the androgenetic alopecia area of involvement, which differentiates it from all other types of LPP. And yet, some authors continue to ignore the peculiarity of the condition and its nosology in relation to PHL, either failing to differentiate it from LPP or interpreting it as a diffuse variant of LPP [9,10], or totally denying the significance of follicular microinflammation and fibrosis in PHL.…”

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confidence: 99%

“…In fact, their comparative histopathology was inappropriate with regard to differences between the 2 groups in sex and age with a predominance of older males in the control group (71% males with 44% >70 years of age with the probability of senescent alopecia vs. 84% females with 3% >70 years of age in the PHL group). In addition, the authors failed to take into account the possibility that the androgenetic hair follicle may react differently to environmental stress and inflammation, as evidenced by basic research [12], or to acknowledge cicatricial PHL or FAPD, as evidenced by the respective clinical observations [6][7][8].…”

mentioning

confidence: 99%