Frontal Alopecia Research Articles

Fibrosing Frontal Alopecia: A comprehensive study to understand its etiology

Objective: To analyze the latest data on the etiology, mechanisms, clinical signs, diagnostic methods and therapeutic approaches for Fibrosing Frontal Alopecia (FFA). Methods: Systematic review organized around five phrases: formulation of the guiding question and the acronym PICO, search for articles and studies in online databases, selection and review of studies, critical evaluation of the material in the selected articles and interpretation of the results. Bibliographic Review: Fibrosing frontal alopecia is a form of acquired primary cicatricial alopecia characterized clinically by a recession of the frontotemporal line, often accompanied by eyebrow alopecia. Its pathophysiology involves immunological, genetic, hormonal, photoexposure, cosmetic use, environmental factors, trauma and stress mechanisms. The diagnosis is made clinically, through physical examinations and trichoscopy, and can be complemented with biopsy and optical coherence tomography. Conclusion: As this is a relatively new pathology, more research is still needed to better understand the disease and establish more effective treatments.

Minoxidil oral en alopecias no androgénicas

For several years minoxidil has been used in medicine and trichology. Its mechanism of action remains unclear, it prolongs anagen, modulates angiogenesis and increases hair shaft thickness. New research suggests an antiandrogenic and immunomodulatory role. Low-dose oral minoxidil has proven to be an alternative for alopecia. The optimal dose for this purpose has not been established, it is probably different for children, women and men. Androgenic alopecia has been the most widely studied condition, there are other pathologies such as telogen effluvium, traction alopecia, alopecia areata, chemotherapy-induced alopecia, loose anagen hair syndrome, monilethrix, and scarring alopecia (fibrosing frontal alopecia and lichen planus pilaris). This literature review aims to expose the mechanism of action, pharmacokinetics, safety and efficacy of oral minoxidil in different types of non-androgenic alopecia.

THU643 Hyperandrogenism Caused By A Steroid Cell Tumor Of The Ovary In A Postmenopausal Woman

Abstract Disclosure: M.S. Myint: None. A. Pinero-Pilona: None. Introduction Steroid cell tumor-not otherwise specified (SCT-NOS) is a subtype of steroid cell tumors which, in turn, is a subtype of sex cord-stroma tumors of the ovary. SCTs are exceedingly rare, account for less than 0.1% of all ovarian tumors, can secrete androstenedione, α-hydroxyprogesterone, and testosterone, and cause hyperandrogenism. We present a case of SCT-NOS, which was revealed postoperatively and was associated with breast cancer. Clinical Case A 74-year-old postmenopausal woman presented approximately a year after the onset of hirsutism, frontal alopecia and an elevated serum total testosterone (TTST) 341 ng/dl (reference range 3 to 41 ng/dL) and free testosterone (FRTST) 10.5 pg/mL (reference range 0.0 to 4.2 pg/mL). She has no clitoromegaly, acne, striae, or changes in voice and no history of infertility or PCOS. Physical examination was significant for cushingoid appearance, frontal alopecia, and hirsutism on the face. Her estradiol level was 213 pg/mL (reference range 0 to 30 pg/mL), FSH and LH levels were in the postmenopausal range, 17-hydroxyprogesterone, DHEA-sulfate, androstenedione, and morning cortisol were normal. Pelvic ultrasonography and CT of the abdomen and pelvis did not reveal an adrenal or ovarian abnormality. We suspected an ovarian source and thus recommended bilateral oophorectomy due to the markedly elevated testosterone level and postmenopausal status. We also started spironolactone. Before setting up for surgery, she was diagnosed with invasive lobular left breast cancer and underwent surgery and radiotherapy. Then, she had bilateral salpingo-oophorectomy. After surgery, TTST dropped to 4 ng/dL and FRTST to 2 pg/mL. Her hyperandrogenic symptoms significantly subsided. Pathology revealed a 1.5 cm red-brown nodule within the left ovary. The nodule contains polygonal cells with vacuolated cytoplasm arranged in nests, cords, and sheets. Cells were positive in calretinin and inhibin and negative in Reinke crystal. A steroid cell tumor, NOS was confirmed. Pathologic features associated with aggressive clinical behavior were not present. Conclusion The incidence of SCT-NOS is highest in women of childbearing age but rare in postmenopausal women. There were only a few case reports of SCT-NOS, most of which are relatively larger and revealed on imaging. In our case, the imaging did not localize the tumor. Sex cord-stromal tumors are often not visualized on imaging. Failure to identify a tumor on imaging does not rule out the presence of a tumor. One should always rule out androgen-secreting tumors in cases of significantly high testosterone. When imaging fails to reveal a tumor, bilateral oophorectomy should be considered in postmenopausal women and an ovarian and adrenal venous sampling in women of childbearing age. It is worth doing so because hyperandrogenism is associated with an increased risk of endometrial and breast cancer. Presentation: Thursday, June 15, 2023

Cutaneous findings in myotonic dystrophy

Myotonic dystrophy types 1 and 2 are a group of complex genetic disorders resulting from the expansion of (CTG)n nucleotide repeats in the DMPK gene. In addition to the hallmark manifestations of myotonia and skeletal muscle atrophy, myotonic dystrophy also affects a myriad of other organs including the heart, lungs, as well as the skin. The most common cutaneous manifestations of myotonic dystrophy are early male frontal alopecia and adult-onset pilomatricomas. Myotonic dystrophy also increases the risk of developing malignant skin diseases such as basal cell carcinoma and melanoma. To aid in the diagnosis and treatment of myotonic dystrophy related skin conditions, it is important for the dermatologist to become cognizant of the common and rare cutaneous manifestations of this genetic disorder. We performed a PubMed search using the key terms “myotonic dystrophy” AND “cutaneous” OR “skin” OR “dermatologic” AND “manifestation” OR “finding.” The resulting publications were manually reviewed for additional relevant publications, and subsequent additional searches were performed as needed, especially regarding the molecular mechanisms of pathogenesis. In this review, we aim to provide an overview of myotonic dystrophy types 1 and 2 and summarize their cutaneous manifestations as well as potential mechanisms of pathogenesis.

Alopecia in preexisting autoimmune thyroid disease in family medicine practice: can hyperprolactinemia induce hair loss? A case report

Management of hair loss in women presents several challenges for general practitioners, who are the first in identifying its cause and consequences in everyday clinical practice. It is usually associated with multiple secondary factors, including endocrine disorders, drug side effects, and physical or emotional stress. We report a possible pathophysiological link between hyperprolactinemia and alopecia in a patient with preexisting autoimmune thyroid disease, which has not been documented in a significant number in the literature. A 27-year-old female patient with a previous history of an autoimmune thyroid disease on hormone substitution therapy presented to a family doctor with signs of frontal alopecia that had started several months previously. On examination, frontal alopecia was confirmed. Laboratory results and thyroid ultrasound confirmed autoimmune thyroid disease, with reduced parathyroid hormone and elevated prolactin. Her female sex hormones were in the normal range. Due to elevated prolactin levels, computed tomography of the pituitary gland was performed, which excluded any brain pathology. Based on available data, there is no published systematic analysis on hyperprolactinemia-induced alopecia in previous autoimmune diseases (large cohort studies). This report indicates that, due to moderately elevated prolactin values, consideration of alternative causes and further diagnostics are necessary to exclude a prolactin-producing tumor of the pituitary gland.

True frontal alopecia in 17th-century paintings

Paintings often show women with a clearance of the frontal hairline. We previously remarked how this was a form of pseudoalopecia that was voluntarily caused by women who shaved the frontal part of their hair for fashionable and esthetic reasons. In this paper, we emphasize in a second set of paintings showing a true alopecia that was caused by traction of the hair due to a tight hairstyle and was culturally favored in the 17th century.

Pasini-Pierini’s atrophoderma and frontal fibrosing alopecia: an unusual association in a young patient

A young woman of 38 years old, followed for fibrosing frontal alopecia under topical coricide, she had presented hypo pigmented macules at the abdominal level, back and thigh, whose histology had concluded a Pasini-Pierini atrophodermia. The association between fibrosing frontal alopecia and Pasinipierini atrophodermia is to our knowledge never described, whose physiopathology is unknown need more studies to explain this association

Clinical-histopathological profile of the frontal fibrosing alopecia: a retrospective study of 16 cases of a university hospital

AbstractBackground: Frontal fibrosing alopecia is a condition of unknown origin, histologically similar to classic lichen planopilaris and generally observed in postmenopausal women with alopecia of the frontal-temporal hairline.Objectives: To describe the clinical, dermatoscopic, and histopathological characteristics and the treatment used in patients who have frontal fibrosing alopecia at the Alopecia Outpatient Clinic in a university hospital.Methods: Retrospective descriptive study performed by reviewing medical charts and biopsies of the scalp.Results: Sixteen patients were analyzed, all of them female, 93.75% of them postmenopausal, and 56.25% brown-skinned. All had frontal alopecia (100%), followed by temporal alopecia (87.5%) and madarosis (87.5%). On dermatoscopy, perifollicular erythema and tubular scales were found as a sign of disease activity. Of the patients, 68.75% had associated autoimmune diseases, including lupus, thyroid disease and vitiligo. Of the 13 biopsies from 8 patients, 10 showed microscopic aspects compatible with frontal fibrosing alopecia. Laboratory tests did not show major abnormalities and minoxidil was the most used treatment.Study limitation: Data collection limited by the study’s retrospective design associated to flaws while filling in the medical charts and absence in standards to the collection and processing of the pathology and histopathological examination.Conclusion: A demographical, clinical, and histopathological description of 16 patients diagnosed with frontal fibrosing alopecia, which remains a challenging disease, of unknown origin, and frequently associated with autoimmune diseases. This study reinforces literary findings. However, more research is needed to establish the pathogenesis and effective treatments.

Frontal pattern hair loss among Chinese women is frequently associated with ponytail hairstyle.

Female alopecia patients in China often present with a frontal pattern hair loss. This feature is seen less frequently in western women. Women in China frequently style their hair in a ponytail. Thus, we hypothesized that the high prevalence of frontal pattern hair loss in Chinese women is due to traction alopecia. To better understand this, we studied 43 women presenting frontal alopecia at a hair clinic. Among the women presenting frontal alopecia, 79% reported styling their hair in a ponytail four or more days per week for an average period of 10 years. To our knowledge, this is the first study to elucidate the cause of frequent frontal alopecia in Chinese women. Although cultural style changes are difficult to change, we believe that awareness of the medical implications of frequent ponytail styling will reduce the rate of frontal alopecia among Chinese women.

A young woman with frontal firbosing alopecia: a case report and review of therapeutic options

A young woman with frontal firbosing alopecia: a case report and review of therapeutic options

Alopécie frontale fibrosante : rôle des écrans solaires

Alopécie frontale fibrosante : rôle des écrans solaires

Cutaneous Neoplasms in Myotonic Dystrophy Type 1

Background: The most frequent skin features associated with myotonic dystrophy type 1 (DM1) are frontal alopecia and pilomatrixomas. Several reports suggest that the incidence of basal cell carcinoma is increased in DM1. However, two recently published studies examining this topic have contradictory results. Objective: To retrospectively study the incidence of cutaneous tumours in patients with DM1. Methods: The clinical features of 102 Caucasian patients diagnosed with DM1 at Bellvitge Hospital in Barcelona, Spain, were retrospectively analysed. Clinical charts of the patients were reviewed, and cutaneous tumours diagnosed in our hospital were recorded. A group of 103 Caucasian patients matched for age and sex were used as the control group. Results: A total of 56 male and 46 female patients with DM1 were included in the study (mean age 49.07 years, SD 13.02). At least 1 basal cell carcinoma was diagnosed in 6 patients in the DM1 group versus 3 patients in the control group (p = 0.332). The mean age at diagnosis of the first basal cell carcinoma was 51 years compared with 66 years in the control group (p = 0.035). Five patients with DM1 presented pilomatrixomas versus none in the control group (p = 0.029). We did not detect any melanoma in our DM1 patients. Conclusion: Basal cell carcinomas appeared at a significantly younger age in our DM1 patients than in the general population, and this suggests that, at least in some patients, DM1 may predispose to the development of basal cell carcinomas.

Androgenic Alopecia and Subclinical Atherosclerosis: Is Any Relationship?

Background and purpose: Androgenic alopecia (AGA) is one of the common presenting problems in dermatology. Relationship between AGA and atherosclerosis/cardiovascular disorders has been surveyed in many studies with different results: some approved it and the others did not. The aim of this study was comparative survey of carotid intima–media thickness between cases with AGA and controls. Subjects and methods: This case control study was conducted from August 2016 to March 2017 at ambulatory dermatology clinics of 2 university hospital, Tehran. The case group consisted of patients with androgenetic alopecia in the range of 18-60 years. The controls were age and “bone mass index” matched friends and families. Individuals with cardiovascular risk factors/diseases were excluded. Carotid intima-media thickness (IMT) was measured at right common Carotid before bifurcation by a faculty radiologist. Data were analyzed in SPSS 22 software. Results: Totally 94 individuals (47 cases, 47 controls) were studied. The case and control groups were matched regarding age and BMI. IMT in the case and control groups were 0.56 ± 0.15 and 0.55 ± 0.14 mm respectively (p=0.674). IMT in the cases with vertex alopecia was significantly higher than frontal alopecia: 0.61 ± 0.14 vs. 0.5 ± 0.14 (p=0.018). Comparison of IMT between cases with vertex alopecia and the controls revealed are not significant difference. Conclusion: This study showed no significant increase of IMT in androgenetic alopecia (especially vertex type) in comparison with the controls. Further studies are recommended.

Hyperandrogenism-Insulin Resistance-Acanthosis Nigricans Syndrome.

Introduction. Female hyperandrogenism is a frequent motive of consultation. It is revealed by hirsutism, acne or seborrhea, and disorders in menstruation cycle combined or not with virilisation signs. Several etiologies are incriminated but the hyperandrogenism-insulin resistance-acanthosis nigricans syndrome is rare. Observation. A 20-year-old girl, having had a five-year-old secondary amenorrhea. The exam revealed a patient, normotensive with a body mass index at 30 kg/m2 and a waist measurement of 120 cm, a severe hirsutism assessed to be 29 according to Ferriman Gallwey scale, virilisation signs of male morphotype, clitoridic hypertrophy and frontal alopecia, and an acanthosis nigricans behind the neck, in the armpits and elbows. The assessment carried out revealed testosteronemia at 1.28 ng/mL, which is more than twice the upper norm of the laboratory. Imaging studies were negative for both ovarian and adrenal masses. The retained diagnosis is HAIR-AN syndrome probably related to ovarian hyperthecosis and she was provided with androcur 50 mg/day and estradiol pills 2 mg/day and under hygiene-dietetic conditions. Conclusion. This case proves that HAIR-AN syndrome could be responsible for severe hyperandrogenism with virilisation signs. It must be retained after discarding the tumoral causes and when there are signs of insulin resistance.

Frontal pseudoalopecia in history: Part 1—Fashionable forms

The progressive recession of the frontal hairline is a common phenomenon in postmenopausal women. It is considered a variant of androgenic alopecia, being related to androgenic hormones; however, postmenopausal frontal fibrosing alopecia is another form of frontal alopecia that is not related to virilization. It was described in 1994, and its pathogenesis is not totally understood.1,2 Frontal fibrosing alopecia shows frontal and parietal hairline recession with frontal alopecia. At the frontal line, the skin is pale without erythema. There is also thinning of the eyebrows. This type of alopecia is perceived with great concern by patients, who consider it antiaesthetic and a source of stress. This feeling has always not been the rule in history. I shall examine two historical periods in which the absence of hair from the frontal areas was acquired because it had aesthetic (it was considered “beautiful”) or social and political (obedience to the emperor) value. In Western cultures, this was common during the Middle Ages, when women voluntarily plucked the hair from the frontal area to look more attractive. This topic is covered in the current report. In Asia, particularly in China during the 1600s, Manchu invaders imposed the style of a shaved frontal area upon the population as a rule of obedience, which will be commented in a future report (Part 2).

Alopecia femenina en el arte

Art reflects life and human society, and many dermatologic diseases have made their way directly or indirectly into works of literature, painting, sculpture, film, and photography. Male baldness is often depicted. Female alopecia, on the other hand, has seldom been a subject for artists because of the psychological implications associated with it and the unfortunate social rejection it symbolizes. Nonetheless, references to women with this condition can be found in art. They are sometimes real historical personages, present for the purposes of historical documentation or as evidence of unusual cases. Alternatively, they may have symbolic value, referring to mythology, conformity, rebellion, or psychological distress. In art, allusions have been made to the clinical manifestations of female pattern baldness (female androgenetic alopecia), alopecia areata, anagen effluvium, and fibrosing frontal alopecia.

Superselective intra‐arterial chemotherapy complications in advanced retinoblastoma

AbstractPurpose The purpose of this study is to report the complications of superselective intra‐arterial chemotherapy with melphalan in children undergoing treatment for advanced intraocular retinoblastoma.Methods 49 eyes of 43 children with advanced intraocular retinoblastoma (Reese‐Ellsworth Group Vb or International Classification Group D) were treated with superselective intra‐ophthalmic artery infusion of melphalan. 22 eyes of 43 children were first diagnosis. 27 eyes of 43 children had previously failed traditional management with systemic chemotherapy and focal therapies and underwent intra‐ophthalmic artery infusion of melphalan as an alternative option to enucleation. Serial complications RETCAM images were collected.Results Ophthalmic artery cannulation was successfully performed in 49 eyes of 43 patients. 9 eyes out of 43 (20.9%) patients were enucleated. 4 eyes out of 43 (9.3%) patients were lost to follow‐up. No severe systemic side effects occurred. Grade III neutropenia was seen in 3 patients (0.6%). No transfusions were required. 25 (58.1%) patients developed eyelid hyperaemia, 10 (23.2%) frontal region skin rash, 12 (27.9%) emiptosis, 6 (13.9%) eyelid edema, 2 (4.6%) frontal alopecia, 2 (4.6%) eyelashes loss, 2 (4.6%) chorioretinal atrophy, 1 (2.3%) acute ischemic optic neuropathy, all resolved spontaneously. 1 case (2.3%) with permanent ptosis underwent surgery. 1 case (2.3%) presented Roth’s spots.Conclusion Ophthalmic intra‐arterial infusion with melphalan is a promising globe‐conserving treatment option in advanced retinoblastoma cases with minimal systemic side effects.

The Rapunzel syndrome: is it an Asian problem? (case report and review of literature)

Trichobezoars are intraluminal accretions of ingested hair. The Rapunzel syndrome is a rare form of gastric trichobezoar, with extension into the small bowel, and may be complicated by obstruction, perforation or peritonitis. The majority of reported cases are from Asian countries. We describe the second case from England who, like the earlier report, is also a 14-year old Asian girl who presented with small bowel obstruction. The pathology was missed 2 years previously when she presented with slim stature, iron-deficiency anaemia and frontal alopecia. This report highlights the need for a higher index of suspicion, particularly in Asian girls to avoid missing the diagnosis and early elective intervention.

Tyrosine Kinase Inhibitors – A Review on Pharmacology, Metabolism and Side Effects

Tyrosine kinase inhibitors (TKI) are effective in the targeted treatment of various malignancies. Imatinib was the first to be introduced into clinical oncology, and it was followed by drugs such as gefitinib, erlotinib, sorafenib, sunitinib, and dasatinib. Although they share the same mechanism of action, namely competitive ATP inhibition at the catalytic binding site of tyrosine kinase, they differ from each other in the spectrum of targeted kinases, their pharmacokinetics as well as substance-specific adverse effects. With variations from drug to drug, tyrosine kinase inhibitors cause skin toxicity, including folliculitis, in more than 50% of patients. Among the tyrosine kinase inhibitors that are commercially available as yet, the agents that target EGFR, erlotinib and gefitinib, display the broadest spectrum of adverse effects on skin and hair, including folliculitis, paronychia, facial hair growth, facial erythema, and varying forms of frontal alopecia. In contrast, folliculitis is not common during administration of sorafenib and sunitinib, which target VEGFR, PDGFR, FLT3, and others, whereas both agents have been associated with subungual splinter hemorrhages. Periorbital edema is a common adverse effect of imatinib. Besides the haematological side effects of most of TKIs like anemia, thrombopenia and neutropenia, the most common extra-heamatologic adverse effects are edema, nausea, hypothyroidism, vomiting and diarrhea. Regarding possible long term effects, recently cardiac toxicity with congestive heart failure is under debate in patients receiving imatinib and sunitinib therapy; however, this observation was probably relate to patients selection, although, TKIs overall appear to be a very well tolerated drug class.

Further phenotypic and genetic variation in ADULT syndrome

ADULT (Acro-dermato-ungual-lacrimal-tooth) syndrome is characterized by ectrodactyly, syndactyly, fingernail and toenail dysplasia, hypoplasia of the breast and nipple, excessive freckling, lacrimal duct atresia, frontal alopecia, primary hypodontia, and/or early loss of permanent teeth. It is a rare autosomal dominant disorder which has been linked to mutation in the p63 gene. The p63 gene has been described in five overlapping limb malformation syndromes including the EEC syndrome (ectodermal ectrodactyly clefting). We report on the first case of ADULT syndrome of a mother and daughter with a new mutation R227Q in exon 6 of the p63 gene. This has not been previously associated with ADULT syndrome but only seen in EEC. In addition to the previously reported features of ADULT syndrome this report also describes some additional findings including hyperextensibility at the distal interphalageal joints, bilateral thumb duplication, bifid toenails, symptoms of urinary retention, vesicoureteric reflux, prominent ears, conductive hearing loss, and an overgrowth of a patch of hair in the midline of the neck. This report expands the knowledge of genotype-phenotype data on the p63 gene and suggests there may be a considerable overlap between the EEC syndrome and the ADULT syndrome.