Frontal fibrosing alopecia: there is no statistically significant association with leave-on facial skin care products and sunscreens

Seegobin, Seth; Tziotzios, Christos; Stefanato, Catherine M.; Bhargava, Kapil; Fenton, David A.; McGrath, John A.

doi:10.1111/bjd.15054

Cited by 16 publications

(10 citation statements)

References 4 publications

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“…Finally, the relatively recent identification of FFA and its apparent increasing incidence have been associated with environmental and dietary factors . Recent case–control studies in both women and men have linked the disease with facial skin care products and sunscreens, although some controversy about this association remains . Specifically, there are still some questions about the pathogenesis of FFA to be answered: (i) Are sunscreens truly associated with the disease?…”

Section: Introductionmentioning

confidence: 99%

“…2,8 Recent case-control studies in both women 6 and men 9 have linked the disease with facial skin care products and sunscreens, although some controversy about this association remains. 10,11 Specifically, there are still some questions about the pathogenesis of FFA to be answered: (i) Are sunscreens truly associated with the disease? (ii) Do patients with FFA have an increased risk of autoimmune or fibrosing diseases?…”

Section: Introductionmentioning

confidence: 99%

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Risk factors associated with frontal fibrosing alopecia: a multicentre case–control study

et al. 2018

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Summary Background Frontal fibrosing alopecia (FFA) is a chronic cicatricial alopecia with an increasing incidence and unknown aetiology. Aim To identify possible environmental and hormonal factors related to FFA. Methods We conducted a multicentre case–control study paired by sex and age, and recruited 664 women (335 cases and 329 controls) and 106 men (20 cases and 86 controls). Study subjects completed an exhaustive questionnaire enquiring about pharmacological, environmental, hormonal, social, job exposure, lifestyle, drugs and diet factors to which they were exposed at least 5 years prior to the onset of the disease. Results For women, there was a statistical association between alopecia and history of pregnancy (OR = 1.6; 95% CI 1.06–2.41), use of facial sunscreen (OR = 1.6; 95% CI 1.06–2.41) and hormone replacement therapy (HRT) (OR = 1.76; 95% CI 1.11–2.8) or raloxifene (no controls exposed therefore OR was not calculated), exposure to alkylphenolic compounds (OR = 1.48; 95% CI 1.05–2.08), and presence of rosacea (OR = 1.91; 95% CI 1.07–3.39), lichen planus pigmentosus (LPP) (OR = 5.14; 95% CI 1.11–23.6) or hypothyroidism (OR = 1.73; 95% CI 1.11–2.69). For men, there was a statistical association between alopecia and use of facial sunscreens (OR = 11.6; 95% CI 1.7–80.9) or antiageing creams (OR = 1.84; 95% CI 1.04–3.23). Conclusions FFA seems to be associated with hormonal exposure (pregnancy, HRT and raloxifene), comorbidities (hypothyroidism, LPP and rosacea) and environmental factors (facial sunscreens, antiageing creams and occupational exposure). Further research is required to analyse the exact mechanism in which these environmental factors participate in the development of this alopecia.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Risk factors associated with frontal fibrosing alopecia: a multicentre case–control study

et al. 2018

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“…While the rising incidence of FFA may be due to increased awareness and reporting, this trend also suggests a possible environmental exposure as a trigger [3,6,9]. Recent surveys of both men and women have noted sta- tistically significant associations between regular facial sunscreen use and FFA prevalence.…”

Section: Discussionmentioning

confidence: 99%

Lichen Planopilaris in the Setting of Hair Sunscreen Spray

Canavan

McClees

Duncan

et al. 2018

Skin Appendage Disord

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Lichen planopilaris (LPP) is a scarring alopecia seen classically in older Caucasian women. Frontal fibrosing alopecia (FFA) is a distinct disease that shares the histologic and trichoscopic features of LPP but differs in its clinical presentation in that it involves the frontal scalp and occasionally the eyelashes and eyebrows of older Caucasian women. Several recent studies have described a link between FFA and the use of sunscreen. Here we report a case of LPP arising in the part line of the scalp of a woman with a history of long-term daily application of spray-on sunscreen to the hair part line.

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“…The observation of both familial FFA[ 18 19 20 ] and more recently, connubial FFA[ 21 ] suggest both genetic and environmental factors, related to either androgenetic alopecia[ 22 ] or to the use of cosmetics and sunscreens,[ 23 24 ] though the latter has been challenged. [ 25 ]…”

Section: Discussionmentioning

confidence: 99%

Autologous hair transplantation in frontal fibrosing alopecia

2018

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We report a patient with frontal fibrosing alopecia (FFA), in whom autologous hair transplantation was successfully performed despite evidence of active disease. Since the underlying pathology of FFA is usually lichen planopilaris, reservations, and caveats have been expressed with respect to the risk of köbnerization phenomena following hair transplantation surgery. An important question that arises is how the lichenoid tissue reaction pattern is generated around the hair follicles in FFA. Follicles with some form of damage or malfunction might express cytokine profiles that attract inflammatory cells to assist in damage repair or in the initiation of apoptosis-mediated organ deletion. Alternatively, an as yet unknown antigenic stimulus from the damaged or malfunctioning hair follicle might initiate a lichenoid tissue reaction in the immunogenetically susceptible individual. Therefore, it might be expected that the transplantation of whole healthy hair follicles might less give rise to an inflammatory reaction than the disease itself, as revealed in our case report of successful hair transplantation in FFA.

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Frontal fibrosing alopecia: there is no statistically significant association with leave-on facial skin care products and sunscreens

Cited by 16 publications

References 4 publications

Risk factors associated with frontal fibrosing alopecia: a multicentre case–control study

Risk factors associated with frontal fibrosing alopecia: a multicentre case–control study

Lichen Planopilaris in the Setting of Hair Sunscreen Spray

Autologous hair transplantation in frontal fibrosing alopecia

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