Frontal Fibrosing Alopecia Research Articles

Botulinum Toxin A Delivery via MMP Technique: An Emerging Therapeutic Approach for Frontal Fibrosing Alopecia

Frontal Fibrosing Alopecia (FFA) is a disease of unknown etiology and pathogenesis whose prevalence has been increasing since its first description in 1994. With no cure, treatments only control the inflammatory process and disease progression, but do not reverse the changes induced by it. We report the case of a patient with early-stage FFA who underwent three monthly sessions of 30 units of Botulinum Toxin Type A administered by MMP® (Microinfusion of drugs through the skin) technique. The results showed a substantial improvement in the patient's clinical condition with inhibition of the inflammatory process and an evident increase in follicular density in the treated area.

Efficacy and safety of toning technique 1064 nm Q‐switched Nd:YAG laser in lichen planus pigmentosus associated with frontal fibrosing alopecia: An open‐label prospective study

Efficacy and safety of toning technique 1064 nm Q‐switched Nd:YAG laser in lichen planus pigmentosus associated with frontal fibrosing alopecia: An open‐label prospective study

Frontal Fibrosing Alopecia: An Observational Single-Center Study of 306 Cases.

(1) Background: Frontal fibrosing alopecia (FFA) is a scarring alopecia that predominantly affects postmenopausal women; (2) Methods: A retrospective, observational, single-center study was conducted in the Hospital General Universitario in Ciudad Real, Spain, including all patients diagnosed with FFA between 2010 and 2021; (3) Results: A total of 306 patients (296 women and 10 men) were included in our study. The mean age of onset was 59.5 years. The severity of this disease was evenly distributed between mild (147 patients) and severe (149 patients) forms. There was a positive, statistically significant, medium correlation between the severity of the disease and its time of progression. Moreover, hypothyroidism was present in 70 patients (22.9%) and classic signs of concomitant lichen planopilaris were observed in just 30 patients (9.8%), while other forms of lichen planus were uncommon. The estimated prevalence in our population is 0.15% and the incidence is 15.47 new cases per 100,000 inhabitants; (4) Conclusions: The time of progression was positively correlated with the severity of FFA. However, the presence of clinical signs, such as inflammatory trichoscopic signs, was not associated with the progression of this condition.

Occipital involvement in classic frontal fibrosing alopecia: Clinical and trichoscopic cross-sectional study in 17 patients

Occipital involvement in classic frontal fibrosing alopecia: Clinical and trichoscopic cross-sectional study in 17 patients

Plasma Rich in Growth Factors as an Adjuvant Treatment for the Management of Frontal Fibrosing Alopecia: A Retrospective Observational Clinical Study.

Frontal fibrosing alopecia (FFA) is a scarring alopecia in which the exact etiopathogenesis has not been completely elucidated and the available treatments are not very effective. Plasma rich in growth factors (PRGF) has shown to induce folliculogenesis in hair loss related disorders. However, the scientific evidence when facing FFA is scarce. The aim of this study was to retrospectively analyze the adjuvant use of PRGF compared to the conventional treatment in the management of FFA. Participants with clinically diagnosed FFA who had been treated with either conventional therapy (Control Group) or conventional therapy combined with PRGF (PRGF Group) were identified from the center's medical records. The clinical assessment was based on the "Frontal Fibrosing Alopecia Severity Score" (FFASS), which was fulfilled during a period of two and 4 years. This study included 118 patients with clinically diagnosed FFA (Control Group: 57 and PRGF Group: 61). No adverse effects related to the treatments were observed. Both treatments showed to halt the steady progression of hair loss compared to baseline. PRGF treatment also induced significant hair regrowth compared to the Control Group. The scalp inflammation was reduced in response to treatments. The FFASS score indicated that PRGF Group improved the symptoms and severity of FFA in a significant manner. The adjuvant use of PRGF may exert long-term beneficial effects on hair loss reduction and might reduce the symptoms and severity of FFA.

Shared Genetic Risk Variants in Both Male and Female Frontal Fibrosing Alopecia

Shared Genetic Risk Variants in Both Male and Female Frontal Fibrosing Alopecia

Frontal Fibrosing Alopecia: A prospective observational study

Introduction: Frontal fibrosing alopecia (FFA) is a scarring alopecia of unknown etiology that affects mainly postmenopausal women. It is responsible for progressive recession of the frontotemporal hairline and sometimes occipital hairline with inconsistent eyebrow hair loss. We aimed to investigate the demographics, clinical and trichoscopic features of FFA in the Moroccan population. Patients and methods: We conducted a prospective study over a period of 2 years and 1/2, from January 2020 to July 2022. We enrolled twenty four patients, with clinical and/or histopathological diagnosis of FFA, seen at the dermatology department of Ibn Rochd University Hospital in Casablanca, Morocco. Data regarding demographics, clinical and trichoscopic findings were collected. Results: Twenty Four patients with FFA met the inclusion criteria. There were all women and half of them were postmenopausal (50%). The average age of disease onset was 46,95 years old. Pruritus was the most reported symptom (80%). An emotional factor was found in 40% of the cases and 45% of the patients reported the use of traditional products to their hairs. All patients presented with frontotemporal hairline recession with parietal or occipital involvement in 70% and 50% of the cases respectively, and 16 patients experienced eyebrow loss. Facial micropapules were found in 9 patients (45%), followed by patchy hyperpigmentation in 6 patients (30%) and follicular hyperpigmentation in 4 patients (20%). The majority of patients presented mild FFA (grades I and II), with a recession of less than 3 cm of the frontotemporal hairline (85%). The most frequent trichoscopic findings were perifollicular erythema (80%) and follicular hyperkeratosis (70%), followed by decreased or absence of vellus hairs (60%), lonely hairs (45%), perifollicular blue-gray pigmentation (35%), perifollicular brownish pigmentation (30%) and loss or absence of follicular openings (30%). Tufted hairs and white patches of scarring alopecia were found in 25% and 20% patients, respectively. Conclusion: Our study supports the role of cosmetic products or emotional factors in the physiopathology of FFA. Trichoscopy seems a valuable tool in the diagnosis of AFF. Perifollicular erythema, follicular hyperkeratosis and decreased of absence of vellus hairs are easily identified and are very suggestive of the diagnosis.

Tacrolimus in Solution as an Option to Inflammatory Conditions of the Scalp.

Several dermatological diseases lead to inflammatory conditions of the scalp. Most of these afflictions are recalcitrant and require long term maintenance treatment. We present a case series where topical tacrolimus was used in a solution vehicle for these conditions. A total of 22 patients (aged 24-90 years) with confirmed diagnosis of lichen planus pilaris (LPP), discoid lupus (DL), frontal fibrosing alopecia (FFA), erosive pustulosis of the scalp (EPS) or folliculitis decalvans (FD) were evaluated and treated with tacrolimus solution (0.1%) applied twice daily for 1 month, then once daily for another month and alternate days for 4 months. Efficacy was evaluated by an investigator global assessment, clinical and dermoscopic evaluation at weeks 4, 8 and 24. The safety assessment included monitoring of all adverse events. The study included 13 patients with LPP, 2 with DL, 2 with FD, 2 with EPS and 3 with AFF. After 1 month, 14 patients (63.6%) had a good response and 7 (31.8%) had excellent response. After 2 months, 16 patients (72.7%) had excellent response, and this response was persistent after 6 months of treatment. Tacrolimus in solution, even if not yet commercially available, was an effective and well tolerated alternative for the maintenance treatment of inflammatory conditions of the scalp.

Frontal fibrosing alopecia and comorbidities in a Moroccan population

Frontal fibrosing alopecia and comorbidities in a Moroccan population

1406 Environmental pathobiology of frontal fibrosing alopecia (FFA): A link between linalool sensitization and FFA development

1406 Environmental pathobiology of frontal fibrosing alopecia (FFA): A link between linalool sensitization and FFA development

Improving hairdressers' knowledge and identification of scarring alopecia using an educational video.

What is known about this subject in regard to women and their families? Hairstylists have a unique role as they are the first people to notice or to be told about a woman’s hair loss complaints. What is new from this article as messages for women and their families? The current study shows that an educational video increases a hairstylist's knowledge regarding clinical signs and symptoms of scarring alopecias, conditions that largely impact women. Dear Editor, Hair loss can have a significant impact on mental health and quality of life. Early detection and treatment of alopecia can help lessen the associated emotional burden and improve patient outcomes.1 Hair stylists make frequent observations of the hair and scalp of their clients and are uniquely positioned to aid in the early detection of dermatologic conditions affecting the hair and scalp. A 2018 study using an educational video was shown to increase hairdresser knowledge and confidence in detecting melanoma in clients.2 Lichen planopilaris (LPP), frontal fibrosing alopecia (FFA), and central centrifugal cicatricial alopecia (CCCA) are 3 forms of inflammatory scarring alopecia that lead to permanent hair loss.3 Early detection of these conditions and referral for diagnosis and treatment are critical. The aim of the current study is to explore whether a video-based education tool aids haircare professionals in identifying early signs of inflammatory scarring alopecia. This institutional review board-approved study included 40 participants with a mean age of 44.1 years and an average of 20.3 years’ experience in the haircare profession. All participants completed a pretest questionnaire to evaluate their knowledge of clinical signs of scarring alopecia. Participants then watched a 15-minute educational video by the supervising author on the topic of signs and symptoms of different types of scarring alopecia with an emphasis on how to identify patients who require urgent dermatologic consultation and completed a posttest questionnaire. Paired t tests were used to measure significant differences between pretest and posttest groups. Concerning participants’ prior hair loss training, 75% reported receiving little to no education about hair loss in their cosmetology curriculum, yet 67.5% reported being asked about hair loss by their clients on a daily or weekly basis (Table 1). Before viewing the educational video, 77.5% of participants had very little or no awareness of/exposure to LPP, FFA, or CCCA. In the post-video questionnaire, the subjects reported greater confidence in their ability to identify LPP, FFA, and CCCA (P < .001) (Table 2). The posttest group showed improvements in knowledge about all aspects of hair loss, with statistically significant improvements in identifying scalp perifollicular erythema and scale as signs of scarring alopecia (50% vs 90%, P < .001). Table 1 - Participant characteristics Female sex, N, % 36, 90 Race, N, % Caucasian 25, 62.5 Black or African American 10, 25 Other 5, 12.5 Age, mean (SD) [range], y 44.1 (10.9) [23–65] Length of time practicing cosmetology, mean (SD) [range], y 20.3 (10.1) [0–38] In cosmetology training, how much education about hair loss, N, % Little or none 30, 75 Some 8, 20 Very much 2, 10 How often do clients ask about hair loss?, N, % Daily 12, 30 Weekly 15, 37.5 Monthly 9, 22.5 Rarely 4, 10 Table 2 - Changes in hairdressers’ scarring alopecia confidence Pre-video confidence in recognizing disorder (0–4) 0 = never heard of it 4 = extremely confident Post-video confidence in recognizing disorder (0–4) P value (paired t test) Lichen planopilaris 0.69 2.47 <.001 Frontal fibrosing alopecia 1.05 2.73 <.001 Central centrifugal cicatricial alopecia 1.08 2.69 <.001 The data demonstrate that an educational video is effective in increasing hairdressers’ knowledge about the clinical signs of inflammatory scarring alopecia. Although the generalizability of these results is limited by a small sample size, this study indicates that training hairdressers in detecting scarring alopecia is a promising avenue for possible earlier detection and improved clinical outcomes. Conflicts of interest None. Funding None. Study approval N/A Author contributions SA: Performance of research, writing/editing, data analysis. MC, IPW, and DH: Writing/editing, performance of research. LB: Research design, performance of research, writing/editing. JP: Research design, writing/editing, supervision. MS: Research design, writing/editing, supervision, data analysis.

Frontal fibrosing alopecia and personal care product use: a systematic review and meta-analysis.

Frontal fibrosing alopecia (FFA) is a cicatricial alopecia affecting the frontotemporal hairline. Given that this scarring, immune-mediated follicular destruction most commonly affects postmenopausal Caucasian women, researchers have postulated that there are hormonal and genetic components; however, the etiology of FFA is still unknown. Recently, dermatologists have reported cases of FFA as being potentially caused by cosmetic products, such as sunscreen and shampoo. Therefore, this systematic review and meta-analysis intend to be the first to analyze the relationship between FFA and cosmetic/personal care products and treatments, including sunscreen, moisturizer, foundation, shampoo, conditioner, hair mousse, hair gel, hair dye, hair straightening/rebonding, chemical/laser facial resurfacing, aftershave, and facial cleanser. The Cochrane, PubMed, EMBASE, and Medline (Ovid) databases were searched for the relevant studies from the date of inception to August 2022. Case-control, cross-sectional, and cohort studies examining the effects of cosmetic/personal care product use on FFA, available in English full-text, were included. Analyses were performed using Review Manager, version 5.4. Results were reported as an odds ratio (OR) with a 95% confidence interval (CI); p values < 0.05 were considered significant. Nine studies were included in our quantitative analyses, totaling 1,248 FFA patients and 1,459 controls. There were significant positive associations found for FFA and sunscreen (OR 3.02, 95% CI 1.67-5.47; p = 0.0003) and facial moisturizer (OR 2.20, 95% CI 1.51-3.20; p < 0.0001) use. Gender sub-analyses demonstrated a positive association for FFA and facial moisturizer in men (OR 5.07, 95% CI 1.40-18.32; p = 0.01), but not in women (OR 1.58, 95% CI 0.83-2.98; p = 0.16). Both gender sub-analyses were significantly positive for the association with facial sunscreen (Male OR 4.61, 95% CI 1.54-13.78, p = 0.006; Female OR 2.74, 95% CI 1.32-5.70, p = 0.007). There was no association found for a facial cleanser (OR 1.14, 95% CI 0.33-1.52; p = 0.51), foundation (OR 1.13, 95% CI 0.83-1.55; p = 0.21), shampoo (OR 0.49, 95% CI 0.22-1.10; p = 0.08), hair conditioner (OR 0.81, 95% CI 0.52-1.26; p = 0.35), hair mousse (OR 1.37, 95% CI 0.75-2.51; p = 0.31), and hair gel (OR 0.90, 95% CI 0.48-1.69; p = 0.74), hair dye (OR 1.07, 95% CI 0.69-1.64; p = 0.77), hair straightening/rebonding (OR 0.88, 95% CI 0.08-9.32; p = 0.92), hair perming (OR 1.41, 95% CI 0.89-2.23; p = 0.14), facial toner (OR 0.51, 95% CI 0.12-2.21; p = 0.37), or aftershave (OR 1.64, 95% CI 0.28-9.49; p = 0.58). This meta-analysis strongly suggests that leave-on facial products, facial sunscreen and moisturizer, are associated with FFA. While the association with facial moisturizer did not persist when stratifying for female populations, gender sub-analyses remained significant for a facial sunscreen. There was no significant relationship found with hair products or treatments. These findings suggest a potential environmental etiology in the development of FFA, particularly UV-protecting chemicals.

Treatment of Frontal Fibrosing Alopecia in Black Patients: A Systematic Review.

Frontal fibrosing alopecia (FFA) is a progressive cicatricial alopecia that can affect patients with skin of color (SOC); however, patients with SOC often are underrepresented in clinical trials and scientific publications on FFA. To better understand the management of FFA in patients with SOC, we sought to assess the clinical evidence for the efficacy of FFA treatment modalities specifically in these patients. This systematic review discusses studies on FFA characteristics and treatment outcomes in Black patients.

Protein profiling of forehead epidermal corneocytes distinguishes frontal fibrosing from androgenetic alopecia.

Protein profiling offers an effective approach to characterizing how far epidermis departs from normal in disease states. The present pilot investigation tested the hypothesis that protein expression in epidermal corneocytes is perturbed in the forehead of subjects exhibiting frontal fibrosing alopecia. To this end, samples were collected by tape stripping from subjects diagnosed with this condition and compared to those from asymptomatic control subjects and from those exhibiting androgenetic alopecia. Unlike the latter, which exhibited only 3 proteins significantly different from controls in expression level, forehead samples from frontal fibrosing alopecia subjects displayed 72 proteins significantly different from controls, nearly two-thirds having lower expression. The results demonstrate frontal fibrosing alopecia exhibits altered corneocyte protein expression in epidermis beyond the scalp, indicative of a systemic condition. They also provide a basis for quantitative measures of departure from normal by assaying forehead epidermis, useful in monitoring response to treatment while avoiding invasive biopsy.

Correlation of clinical, histopathologic, and direct immunofluorescence findings in lesional and nonlesional scalp of frontal fibrosing alopecia and lichen planopilaris – An observational study

Correlation of clinical, histopathologic, and direct immunofluorescence findings in lesional and nonlesional scalp of frontal fibrosing alopecia and lichen planopilaris – An observational study

Frontal fibrosing alopecia, clinical and histopathological characteristics of mexican patients: an original research study and review of literature

Background: Frontal Fibrosing Alopecia (FFA) was described at twenty-century, and cases increased exponentially. FFA has a great impact on patient’s quality life. Objective: Thus, the aim of this work was report FFA cases attended during a fifteen-year period. Material and methods: A retrospective study was carried out, including patients with FFA diagnosis treated at Dermatology department. Data were obtained from the clinical files, and tissue slices were reviewed. Results: Thirty-seven patients FFA were identified. Ninety-seven percent (n= 36) were women, with an average age of 57.8 years (range between 35 to 86 years). Eighty-one percent presented with recession of implantation line as the main clinical manifestation; the predominant histological pattern was scarring alopecia, presented in 34 patients (91.8%). Discussion: Increased of the pathology was observed in the last five years, since 2017. FFA is a newly diagnosed disease with increased prevalence in Mexico, where it occurs predominantly in postmenopausal women. Conclusion: Mexican patients presented in late stages of the disease, with mean ages lower than other series, so in our country the challenge is to identify the FFA in early stage and prevent disease progression and the irreversible alopecia.

Translated article] Trichoscopy: An Update

Trichoscopy is a simple, noninvasive office procedure that can be performed using a handheld or digital dermatoscope. This tool has gained popularity in recent years, because it provides useful diagnostic information for hair loss and scalp disorders by enabling the visualization and identification of distinctive signs and structures. We present an updated review of the trichoscopic features described for some of the most common hair loss disorders seen in clinical practice. Dermatologists should be familiar with these helpful features, as they can significantly aid the diagnosis and follow-up of numerous conditions, such as alopecia areata, trichotillomania, and frontal fibrosing alopecia.

Study of the Thyroid Profile of Patients with Alopecia.

Thyroid hormones are required for the physiological growth and maintenance of hair follicles. We aim to study the thyroid profile of patients with alopecia. This is a narrative review. PubMed literature was searched from 2013 to 2022. We followed different types of alopecia: alopecia areata (AA), androgenic alopecia in males and females, telogen effluvium (TE), frontal fibrosing alopecia (FFA), lichen planopilaris, and alopecia neoplastica (AN). AA shares a common autoimmune background with autoimmune thyroid diseases, either sporadic or belonging to autoimmune polyglandular syndromes. Some data suggested that AA is more severe if thyroid anomalies are confirmed, including subclinical dysfunction or positive antithyroid antibodies with normal hormone values. However, routine thyroid screening for patients with AA, if the patients are asymptomatic from a thyroid point of view and they have negative personal and family history of autoimmunity, remains controversial. TE, apart from the autoimmune type, associates thyroid anomalies of a hormonal assay (between 5.7% and 17%). FFA, mostly a postmenopausal entity (however, not exclusive), associates a higher prevalence of thyroid conditions (up to 50%) than the general population. However, these might have an age-dependent pattern, thus the association may be incidental since there are a limited number of studies. Overall, alopecia remains a very challenging condition for patients and physicians; a multidisciplinary team is required to improve the outcome and quality of life. The common autoimmune background is suggestive of some types of alopecia and thyroid disorders, yet, the underlying mechanisms are still a matter of debate. AA, TE, FFA, LPP, and, potentially, female pattern hair loss have been found to be connected with thyroid entities, thus a state of awareness from a dual perspective, of trichology and endocrinology, is helpful.

Oral Low-Dose Naltrexone in the Treatment of Frontal Fibrosing Alopecia and Lichen Planopilaris: An Uncontrolled Open-Label Prospective Study.

Background Frontal fibrosing alopecia (FFA) and lichen planopilaris (LPP) is scarring alopecias with limited evidence supporting their treatment options. We investigated the use of low-dose naltrexone (3 mg oral daily) as adjunctive therapy in the treatment of FFA and LPP. Methods A single-center, uncontrolled open-label prospective study was performed, with 26 patients who took low-dose naltrexone for one year included in the per-protocol analysis. Both patient-reported (pruritus and burning/pain) and physician-assessed (erythema, scale, and scalp involvement) outcomes were analyzed. Results There were decreases in erythema and scale for the overall longitudinal outcomes using linear mixed effects model analysis. However, only erythema had a significant decrease at 12 months compared with baseline. Mean erythema decreased by 0.93 at 12 months compared with baseline on a 0-3-point scale (p<0.0001, 95% mean CI [-1.32, -0.53]). There was no statistically significant difference comparing 12 months to baseline for the other outcomes including pruritus, burning/pain, and scalp involvement. Limitations include the possibility of spontaneous stabilization, concurrent medications, a small sample size with limited racial diversity, and mild subjective symptoms at baseline. Conclusion Our study supports further investigation of oral low-dose naltrexone as adjunctive therapy in the treatment of FFA and LPP if there is prominent erythema, and possibly scale.

Treatment of Frontal Fibrosing Alopecia

Introduction. Frontal fibrosing alopecia (FFA) is known as a lymphocytic primary cicatricial alopecia. The main characteristic of FFA is progressive frontotemporal hairline recession. The pathogenesis of FFA is not completely understood. Destructing the stem cells of the epithelial hair follicles causes permanent hair loss and seems to be the main cause of FFA. Studies have reported significantly decreased quality of life in patients with hair loss. On the other hand, late diagnosis and treatment of FFA can decrease the success rate of the treatment. In this regard, different topical and systemic therapies have been developed to resolve the symptoms; however, only a partial response to treatment is usually achieved. We conducted a systematic review of the literature to identify the effectiveness of the available treatment modalities used for FFA patients and the related outcomes. Methods. On April 2022, we made a wide systematic computer‐assisted search of PubMed and Google Scholar databases, using “frontal fibrosing alopecia” and “treatment” keywords. We scanned 1,514 articles. All the studies concerning a therapeutic regimen for FFA were included. After removing duplicate studies, 50 studies containing the therapeutic regimen of 1,478 FFA patients were included in this review. Results. The 5‐alpha‐reductase inhibitors (oral finasteride/dutasteride) were the most used medications (usually prescribed as a combination therapy with other medications). Topical corticosteroids were the second commonly used medication for the treatment of FFA. Systemic corticosteroids seem to be ineffective in improving FFA progression. Oral isotretinoin (or alitretinoin) had the most promising effect on improving facial papules of FFA patients with a 92% rate of facial papule improvement. Conclusion. In our review, intralesional corticosteroid injection and 5‐alpha‐reductase inhibitors (finasteride/dutasteride) were reported as the most effective treatment modalities. Oral isotretinoin (or alitretinoin) is considered as the most promising treatment for improving facial papules in the context of FFA. However, it had minimal effects on hair regrowth or stabilization of hairline recession in FFA patients.