Frontal fibrosing alopecia in Asians: a retrospective clinical study

Abstract

BackgroundFrontal fibrosing alopecia (FFA) is a distinctive form of primary lymphocytic cicatricial alopecia and predominantly occurs in postmenopausal women. The condition is increasing in prevalence worldwide. However, there is a paucity of information regarding FFA in Asians because of a lack of published literature. We aimed to describe the demographics, clinical and trichoscopic features, and treatment outcomes of FFA in Asian patients.MethodsWe conducted a retrospective clinical study including patients diagnosed with FFA. Data regarding demographics, clinical and trichoscopic findings, and treatment outcomes were collected. The data were analyzed using descriptive statistics.ResultsFifty‐six Thai patients with FFA met the inclusion criteria. There were 54 females (96.4%) and two males (3.6%), and the average age of disease onset was 51.3 ± 6.3 years. All patients presented with frontotemporal hairline recession, and 49 patients (87.5%) experienced eyebrow loss. Trichoscopy in 35 patients revealed follicular dropout, perifollicular erythema, and lonely hair in 35 (100%), 29 (82.8%) and 26 patients (74.2%), respectively. Disease stabilization was superiorly observed in patients treated with a combination of topical corticosteroids and hydroxychloroquine or finasteride (79.3% and 73.3%, respectively).ConclusionOur study presents the largest series of FFA in Asians and reports mixed clinical patterns between Caucasian and African patients. Combination therapy of topical corticosteroids and hydroxychloroquine or the use of topical corticosteroids and finasteride may halt the progression of FFA in Asians.

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

“…Among them, thyroid diseases are the most common with prevalence ranging 4-37%. 7,8,16,35 In our study, the most common thyroid diseases were hypothyroidism (4/8), followed by papillary thyroid cancer, Graves' disease and thyroid nodule. From all evident studies, routine measurement of thyroid functions and autoantibodies in FFA patients is recommended.…”

“…Frontal fibrosing alopecia is known to be common in postmenopausal Caucasian women but recently this disease has been reported in various races, as well as premenopausal women, men 5,7,[13][14][15] and even in a pediatric population. 5 The mean age of onset in our study is similar to previous reports with the youngest patient in our study being 34 years old (Table 4).…”

“…26,27 In our study, 34.5% of FFA patients underwent hysterectomy, which is more frequent than previous studies and general population. 7,8,28 The condition of early menopause and sudden hormonal changes may be one of the stimulators of disease development. 29 However, a majority of our patients had no abnormality in their sex hormone profiles (low estradiol, high level of FSH, low testosterone, low free androgen index and normal DHEA-S; data not shown).…”

“…Most FFA series are retrospectively reported from Caucasian patients, with only a few from Asian populations. 7 To improve knowledge on this increasingly common disease, a standardized data collection of FFA patients was established at King Chulalongkorn Memorial Hospital (KCMH), Bangkok, Thailand. The demographic data, clinical characteristics, trichoscopic features, treatment employed and their outcomes, hormonal factors and environmental factors were investigated.…”

“…Frontal fibrosing alopecia is believed to show racial preference. Most FFA series are retrospectively reported from Caucasian patients, with only a few from Asian populations 7 . To improve knowledge on this increasingly common disease, a standardized data collection of FFA patients was established at King Chulalongkorn Memorial Hospital (KCMH), Bangkok, Thailand.…”