Original article
Frontal fibrosing alopecia: A multicenter review of 355 patients

https://doi.org/10.1016/j.jaad.2013.12.003Get rights and content

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.

Section snippets

Methods

This multicenter study included 12 Spanish centers applying the methodology as described below at all centers. A retrospective observational and analytic review was designed including patients given the diagnosis of FFA from 1994 to 2013. Diagnosis was made histologically or based on the typical clinical presentation (irregular recession of the frontotemporal and preauricular hairline with eyebrow loss) and characteristic dermoscopic findings. All doubtful cases including men and premenopausal

Results

A total of 355 patients (343 women [49 premenopausal] and 12 men) with a mean age of 61 years (range 23-86) were included in the study. All were Caucasian except for 3 black-skinned women (0.9%) and 2 gypsy women (0.5%). The mean age of menopause was 49 years (range 23-60). Early menopause (≤45 years) was detected in 49 patients (14%), with a surgical cause in 31 of them (9%). A total of 46 patients (13%) underwent hysterectomy (31 premenopausal and 15 postmenopausal). The mean age of onset of

Discussion

FFA is a primary scarring alopecia and is considered to be a variant of LPP with a characteristic clinical pattern of progressive frontotemporal hairline recession and eyebrow loss. It occurs mainly in postmenopausal women,1, 20 although premenopausal women2, 11, 12, 17, 21, 22 and men23, 24, 25 may also be affected. The mean age of onset in our study is similar to previous reports (Table III).8, 11, 16 The youngest patient of our study was a 23-year-old man, which is, to our knowledge, the

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    Funding sources: None.

    Conflicts of interest: None declared.

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