Frontal Fibrosing Alopecia Research Articles

Response to Truel J., “Response to “Topical tofacitinib for patients with lichen planopilaris and/or frontal fibrosing alopecia””

Response to Truel J., “Response to “Topical tofacitinib for patients with lichen planopilaris and/or frontal fibrosing alopecia””

Assessment and Validity of Trichoscopy for Eyebrow Involvement in Lichen Planopilaris: A Case-Control Study

Introduction: Few publications are available on eyebrow trichoscopy in patients with alopecia areata and frontal fibrosing alopecia (FFA). Objective: We aimed to investigate the validity of using trichoscopy to examine the eyebrow involvement in patients with lichen planopilaris (LPP) and its variants. Methods: In this case control study, 109 patients with eyebrow involvement in LPP and FFA (cases) and with acquired hair disorders of the eyebrows (controls) were included. Results: Trichoscopy was highly specific and sensitive for the diagnosis of LPP and its variants, including FFA. Trichoscopic features significantly associated with LPP were peripilar scaling, peripilar pigmentation, broken hairs, peripilar white halos, diffuse empty follicles, and vellus hair. Localized peripilar erythema and empty follicles were significantly associated with the diffuse form of LPP and zigzag-type FFA. Yellow dots, dystrophic hairs, regrowth in different directions, and diffuse empty follicles were associated with LPP activity and FFA severity. Conclusions: Trichoscopy is a valid tool for evaluating eyebrow involvement in LPP. Thus, it could help increase the diagnostic accuracy and predict the prognosis of eyebrow hair loss at an early stage.

Treatment outcomes and Follow-Up results of a sample of females with Frontal fibrosing Alopecia

Treatment outcomes and Follow-Up results of a sample of females with Frontal fibrosing Alopecia

A phase 2a trial of brepocitinib for cicatricial alopecia

BackgroundCicatricial alopecias (CA) are chronic, progressive scarring hair-loss conditions. Molecular dysregulation is not fully understood, hindering treatment development. Th1/IFNγ signaling and JAK dysregulation has shown involvement, providing rationale for this phase 2a trial with TYK2/JAK1 inhibitor brepocitinib. MethodsRandomized, placebo-controlled phase 2a trial spanning 52 weeks. Adults (18≥years of age) with lichen planopilaris, frontal fibrosing alopecia, or central centrifugal cicatricial alopecia diagnosis were randomized 3:1 to brepocitinib 45mg daily or placebo for 24 weeks, after which all patients received brepocitinib for another 24 weeks, with a safety follow up 4 weeks later. Lesional scalp biopsies were collected at baseline, week 24, and week 48. Co-primary endpoints were changes in lesional expression of CCL5, changes in lesional expression of fibrosis-related markers, and safety at week 24. ResultsPatients receiving brepocitinib showed significant downregulation in CCL5 expression at week 24 (p=0.004). Enrichment analysis of a subset of fibrosis markers showed trending upregulation in placebo patients (p<0.1). Brepocitinib was well tolerated and improved clinical severity scores. LimitationsSingle-dose regimen, small placebo group. ConclusionBrepocitinib significantly reduces CCL5 expression and was well tolerated at week 24, meeting co-primary endpoints. Brepocitinib reduces inflammatory biomarker expression and improves clinical severity, while maintaining favorable safety profile.

Efficacy of Methotrexate Microinfusion in Scalp Lesions of Patients with Frontal Fibrosing Alopecia: A Prospective Controlled Trial

Introduction: Topical and systemic drugs, as methotrexate (MTX), do not control the frontal fibrosing alopecia (FFA) activity in most of the cases showing the need for new therapies. Therefore, we aimed to evaluate the effectiveness of MTX microinfusion in FFA. Methods: Prospective, controlled clinical trial, carried out with 17 volunteers with clinical and histological diagnosis of FFA. Applications of MTX by MMP® (microinfusion of drugs into the skin method) were made every 30 days, in a total of 03 applications, in the right half of the alopecia area; the other half served as a control. Results: There was a significant reduction in frontal-glabella and frontal temporoparietal measurements at treated site while in the untreated site the FFA increased. Patient’s referred improvement of pruritus and desquamation but not in hair loss and local erythema. Analysis of the dermoscopic photos and the LPPAI calculation did not show relevant changes. About 95% of the participants were satisfied or very satisfied with the results and none of them had alteration in the laboratory test results. Conclusion: The MTX application by MMP® improved symptoms associated with FFA, and the frontal-glabella and frontal temporoparietal measurements. This technique proved to be safe and well tolerated.

Send in the Clowns: A Special Tribute to Medical Clowning and Clown Eponyms in Dermatology

Clowns have long delighted circus crowds and are celebrated not only in popular culture but also in the dermatology literature as medical eponyms. This contribution discusses four such eponyms: 1) clown nose-like lesion, 2) clown eczema (perioral dermatitis) 3) clown alopecia pattern in frontal fibrosing alopecia and 4) clown's face of Brachman de Lange syndrome (Cornelia de Lange syndrome). This contribution also highlights the role of medical clowning in patient care by paying tribute to Cobo the Clown, also known as Barbara Joyce Cohen, who has served as a dedicated caring clown for over thirty years.

52986 Highlighting the Link between Lichen Planus Pigmentosus and Frontal Fibrosing Alopecia: A Case Series of 3 Patients

52986 Highlighting the Link between Lichen Planus Pigmentosus and Frontal Fibrosing Alopecia: A Case Series of 3 Patients

Treatment of Lichen Planopilaris and Frontal Fibrosing Alopecia: A Retrospective, Real-Life Analysis in a Tertiary Center in Germany.

Background: Lichen planopilaris (LPP) is an inflammatory cicatricial alopecia characterized by an irreversible destruction of the hair follicle resulting in its permeant destruction. The clinical presentation of LPP is a progressive patchy scarring alopecia. A variety of systemic agents is used to treat LPP with varying success. The aim of this retrospective, real-life analysis was to evaluate the treatment of hydroxychloroquine for LPP. Method: In this retrospective, single-center study, we analyzed 110 patients with LPP and frontal fibrosing alopecia (FFA) who received treatment over a 12-month period from March 2014 to March 2021 at the Department of Dermatology, University of Mainz Medical Center. Patient records were analyzed for response to treatment, co-morbidities, disease progression-free survival (DPFS), and safety. Clinical parameters associated with treatment response were determined with Cox regression modelling and logistic regression. Results: Overall, 77 of 110 patients were treated with a systemic agent. There was a clear association between LPP and the occurrence of Hashimoto thyroiditis. Topical treatment with corticosteroids did not improve clinical symptoms in the majority of patients (15 out of 101). In 71% of patients treated with systemic cyclosporine A and 62% of patients treated with hydroxychloroquine, we observed a significant resolution of the inflammatory process, which correlated with a robust durable clinical response (p < 0.001). Toxicity was observed in 17% (n = 9) of patients receiving systemic treatment with hydroxychloroquine and correlated with the duration of systemic treatment (p < 0.001). Treatment discontinuation was associated with a flare-up of clinical symptoms (29%), which required the re-initiation of second-line therapy in 13 out of 51 patients. Overall, the initiation of second-line treatment, either hydroxychloroquine or Cyclosporine A (CsA), yielded positive results, especially in the patient cohort treated with hydroxychloroquine (overall response rate, ORR = 100%), who showed disease progression during CsA or retinoids. Conclusions: Our results from this contemporary cohort of patients with LPP and FFA indicate that hydroxychloroquine and cyclosporine are effective systemic agents in decreasing clinical symptoms. However, our data also show that the discontinuation of treatment is often associated with the exacerbation of clinical symptoms. Response rates to second-line treatment were especially favorable in the patient cohort with hydroxychloroquine.

A clinical trial on the efficacy of mesotherapy with dutasteride for frontal fibrosing alopecia

A clinical trial on the efficacy of mesotherapy with dutasteride for frontal fibrosing alopecia

Pruritus in Lichen Planopilaris and Frontal Fibrosing Alopecia—Clinical Characteristics and Dermoscopic Correlations

Background: Lichen planopilaris (LPP) and frontal fibrosing alopecia (FFA) are the most common causes of lymphocytic scarring alopecia. Itching of the scalp is a common accompanying symptom. The aim of the study was the clinical assessment of pruritus and its correlation with dermoscopic features. Methods: Sixty-one patients with scarring alopecia were analyzed (LPP = 16; FFA = 33; coexisting LPP-FFA = 12). Each patient underwent a trichoscopic examination. Itch severity and characteristics were assessed using a Visual Analogue Scale (VAS), 4-item Itch Questionnaire and 12-item Descriptive Pruritus Assessment Questionnaire. Results: Itching of the scalp occurred in 73.8% of the patients (mean maximal VAS 5.3 ± 3.1 points). Pruritus was most frequently accompanied by tingling (19.7%) or burning (14.8%) sensations. The following factors most frequently increased the severity of pruritus: sweating, heat, stress and hot water. On the other hand, cold water and cold air often relieved symptoms. There was a significant relationship between itch and perifollicular scaling (p = 0.011), hair diameter diversity (p = 0.008) and white halo (p = 0.016). Conclusions: Pruritus was the main subjective complaint reported by patients suffering from LPP and FFA. A better understanding of pruritic features may help in the selection of an effective therapeutic strategy.

Quality of life assessment and the impact of an early diagnosis and treatment in Lichen planopilaris: a systematic review.

Lichen planopilaris (LPP) and its variants, mainly frontal fibrosing alopecia (FFA), affect the hair follicles causing cicatricial alopecia with a significant negative impact on self-confidence and quality of life (QoL). This systematic review investigates the psycho-emotional impact of LPP and its variants using PRISMA guidelines. The review revealed that LPP and FFA cause significant psychological distress and impaired QoL. Higher LPP disease activity and severity were associated with higher depression, higher anxiety scores, lower quality-of-life scores, and higher scores of role limitations (physical and emotional). Additionally, facial lesions in FFA patients, especially the eyebrows involvement can be very distressing, leading to impaired self-esteem and QoL. this negative impact of active and severe LPP and FFA on QoL and self-esteem of patients causes psychiatric conditions including anxiety and depression. Therefore, an early diagnosis must be encouraged in these patients.

Isotretinoin as a promising option in the treatment of facial papules of frontal fibrosing alopecia.

Frontal fibrosing alopecia (FFA) is a primary cicatricial alopecia characterized by hairline recession, pruritus, and facial papules (FP). Various therapies are used to stabilize disease activity and induce remission. However, FP of FFA is resistant to treatment in many cases. In this review, we searched the PubMed and Google Scholar databases to screen the published literature on treatment options for FP in the context of FFA. Overall, 12 studies were included in this review. Available literature suggests a noticeable improvement in resistant-to-treatment FP in FFA patients with oral isotretinoin. The available evidence is limited and is derived from retrospective studies and case reports/series. Systemic isotretinoin can be considered a promising therapeutic regimen for treating resistant-to-treatment FP of FFA patients. However, more extensive, well-designed studies are necessary for confirmatory evidence.

Characteristics of pruritus in lichen planopilaris and frontal fibrosing alopecia: A cohort study in a French hospital

Characteristics of pruritus in lichen planopilaris and frontal fibrosing alopecia: A cohort study in a French hospital

Slowed-down temporal vein refilling as diagnostic pearl in frontal fibrosing alopecia

Slowed-down temporal vein refilling as diagnostic pearl in frontal fibrosing alopecia

Clinicopathological Features of Frontal Fibrosing Alopecia (FFA) in 26 females: A Retrospective Study

Clinicopathological Features of Frontal Fibrosing Alopecia (FFA) in 26 females: A Retrospective Study

Upregulation of caveolae-associated structural proteins in the hair follicle bulge of lichen planopilaris and frontal fibrosing alopecia.

Lichen planopilaris (LPP) and frontal fibrosing alopecia (FFA) are primary cicatricial alopecia that cause a major impact on quality of life due to irreversible hair loss and symptoms as itching, burning and pain. They are characterized by permanent loss of hair follicle stem cells (HFSCs) by pathomechanisms still poorly understood, resulting in poor efficacy of currently available treatments. Caveolae are flask-shaped lipid rafts invaginated within the plasma membrane of multiple cell types. Although their role in the HF physiology and pathophysiology is relatively unknown, we have previously demonstrated that the primary structural component of caveolae (caveolin-1 or Cav1) is upregulated in FFA. Thus, we propose to investigate the expression and localization of caveolae-associated structural proteins (Cav1, Cav2, and Cavin-1) and HFSCs (identified by K15) in both LPP and FFA. We analyzed 4 patients with LPP biopsied in affected and non-affected (NA) scalp, 4 patients with FFA biopsied in affected scalp and 4 healthy controls. Affected scalp of LPP and FFA demonstrated increased levels of Cav1 and Cavin-1 compared with HC and LPP-NA. Moreover, Cav1, Cav2 and Cavin1 all exhibit high colocalization with K15 and their expression appears to be negatively correlated, supporting the hypothesis that these proteins are important players in LPP/FFA and may serve as therapeutic targets in future treatments.

Frontal fibrosing alopecia—A new absolute contraindication for deep chemical peels

Frontal fibrosing alopecia (FFA) is characterized by a receding hairline in the frontotemporal region due to the gradual loss of hair follicles and then follicular stem cells and follicular fibrosis. Follicular stem cells are crucial in skin healing after chemical peeling and other resurfacing procedures. Although there is a possible association of FFA with a history of facial and scalp surgical procedures, there is no information on the safety of cosmetic procedures in patients with FFA. We report five patients with FFA who experienced unusual and complicated outcomes after undergoing a deep chemical peel (phenol and croton oil). As the prevalence of FFA continues to increase globally, it is essential to raise awareness about the potential incompatibility of this dermatologic disorder with specific cosmetic procedures, such as deeper peels and other resurfacing modalities.

Enhanced Insights into Frontal Fibrosing Alopecia: Advancements in Pathogenesis Understanding and Management Strategies.

Frontal fibrosing alopecia (FFA) represents a distinctive form of primary lymphocytic scarring alopecia characterized by fronto-temporal hair recession and eyebrow hair loss. While predominantly affecting postmenopausal women, FFA also occurs in women of reproductive age and men, with variations observed across different ethnic groups. Genetic predisposition, environmental factors and inflammatory pathways contribute to its pathogenesis, with evolving diagnostic criteria enhancing accuracy. FFA treatment lacks standardization, encompassing topical, systemic and physical therapies, while hair transplantation remains a temporary solution. This article reviews the current understanding of FFA, aiming to provide clinicians with updated insights for its management.

Common contact allergens implicated in frontal fibrosing alopecia found in over-the-counter hair growth serums and solutions

Background: Frontal fibrosing alopecia (FFA) is a form of lichen planopilaris with an undetermined etiopathogenesis, predominantly affecting women. There is conflicting evidence as to whether contact allergens may play a role in the underlying etiology or progression of FFA. Objective: The aim of this study is to find the most common products that patients search for online, identify contact allergens present in these advertised over-the-counter hair products, and suggest their role in the development or exacerbation of FFA. Methods: We reviewed current research on this topic and then investigated common allergens found in over-the-counter hair products commonly used for hair regrowth. Results: FFA’s exact etiopathogenesis remains vastly unknown, however, current literature has reported an association between inflammatory skin conditions and FFA. Limitations: The lack of published data on the function of contact allergens in FFA placed restrictions on our study. Conclusion: A survey-based analysis with a larger cohort is needed to further interpret the relationship between product use and FFA presentation based on contact allergens. More research on possible etiopathogenesis and the relationship between contact dermatitis and FFA may prevent further progression of a patient’s disease, leading to an improvement in their quality of life.

Response to "Cetrimonium Bromide Patch Test Positivity Is Found With a High Frequency in a Cohort of Patients With Frontal Fibrosing Alopecia".

Response to "Cetrimonium Bromide Patch Test Positivity Is Found With a High Frequency in a Cohort of Patients With Frontal Fibrosing Alopecia".