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Frontal fibrosing alopecia: A multicenter review of 355 patients

Published:February 07, 2014DOI:https://doi.org/10.1016/j.jaad.2013.12.003

      Background

      To our knowledge, there are no large multicenter studies concerning frontal fibrosing alopecia (FFA) that could give clues about its pathogenesis and best treatment.

      Objective

      We sought to describe the epidemiology, comorbidities, clinical presentation, diagnostic findings, and therapeutic choices in a large series of patients with FFA.

      Methods

      This retrospective multicenter study included patients given the diagnosis of FFA. Clinical severity was classified based on the recession of the frontotemporal hairline.

      Results

      In all, 355 patients (343 women [49 premenopausal] and 12 men) with a mean age of 61 years (range 23-86) were included. Early menopause was detected in 49 patients (14%), whereas 46 (13%) had undergone hysterectomy. Severe FFA was observed in 131 patients (37%). Independent factors associated with severe FFA after multivariate analysis were: eyelash loss, facial papules, and body hair involvement. Eyebrow loss as the initial clinical presentation was associated with mild forms. Antiandrogens such as finasteride and dutasteride were used in 111 patients (31%), with improvement in 52 (47%) and stabilization in 59 (53%).

      Limitations

      The retrospective design is a limitation.

      Conclusions

      Eyelash loss, facial papules, and body hair involvement were associated with severe FFA. Antiandrogens were the most useful treatment.

      Key words

      Abbreviations used:

      5aRi (5-alpha-reductase inhibitors), AGA (androgenetic alopecia), CI (confidence interval), FFA (frontal fibrosing alopecia), LPP (lichen planopilaris), OR (odds ratio)
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      Linked Article

      • Frontal fibrosing alopecia
        Journal of the American Academy of DermatologyVol. 71Issue 3
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          To the Editor: We were interested to read the review of 355 cases of frontal fibrosing alopecia (FFA) in a Spanish population recently published in this journal by Vaño-Galván et al.1 As the authors indicated, this intriguing condition is being seen with increasing frequency yet the cause(s) remain uncertain. In this cohort the majority (87%) were nonsmokers, however, this was not statistically different from age-matched unaffected Spanish women. In their commentary, the authors referred to a study we published in this journal in 2012,2 suggesting we concluded smoking to be protective against FFA.
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