Frontal Fibrosing Alopecia Research Articles

204 Adverse events associated with hydroxychloroquine use in cicatricial alopecia patients

The anti-malarial hydroxychloroquine (HCQ) is a common treatment for cicatricial alopecias (CA). Serious adverse events include prolonged QT interval, ventricular arrythmias and irreversible retinopathy. There is limited literature on the incidence of adverse events in CA patients taking HCQ. A retrospective analysis was performed of 60 CA patients, mean age 60 years, prescribed HCQ. Alopecia diagnoses included lichen planopilaris, frontal fibrosing alopecia, discoid lupus, central centrifugal cicatricial alopecia and folliculitis decalvans. Average length of HCQ treatment was 2.98 years. Dosing ranged from 100 to 400 mg daily. 83.3% of patients did not experience an adverse event. Adverse events that occurred include GI distress (n=5), tinnitus or other hearing-related changes (n=2), and allergic skin rash (n=1). One patient developed non-sustained ventricular tachycardia (NSVT) 17 months after starting HCQ 400 mg daily. During her hospitalization, no structural cardiac abnormalities were revealed, and the cause of the NSVT was not determined. She was prescribed daily estradiol-norethindrone hormone replacement therapy (HRT) for several years prior to the NSVT. Her medical history was significant for congestive heart failure and remote history of pulmonary hypertension and left ventricular hypertrophy. The patient permanently discontinued both medications. She has not developed another NSVT episode and remains healthy. Within our cohort, there were no other cardiac related events despite some patients taking concomitant medications known to increase risk of QT prolongation. These patients were monitored with regular electrocardiograms. The risk of HCQ-associated retinopathy increases with > 5 years of cumulative use. No patients included in our analysis developed retinopathy, including the 6.67% taking HCQ for > 5 years. We demonstrate that while adverse events may occur during treatment, HCQ is generally well tolerated by CA patients. We hope this will help support treatment discussions with CA patients.

Assessment of health-related quality of life in patients with frontal fibrosing alopecia.

Frontal fibrosing alopecia (FFA) is a primary patterned cicatricial alopecia with different manifestations. Its incidence is increasing worldwide. Like other types of alopecia, FFA can affect patients' health-related quality of life (HRQOL). However, this effect has been rarely discussed. This study was designed to evaluate HRQOL in patients with FFA. In this cross-sectional study, 49 patients with confirmed FFA were asked to complete Dermatology Life Quality Index (DLQI) and the 36-Item Short Form Survey (SF-36) questionnaires. Disease severity was evaluated with the Frontal Fibrosing Alopecia Severity Score Index (FFASI). Significant relation between SF-36 scores and other covariants was not detected. According to the DLQI, most of the patients (54%) had impaired HRQOL, which was of low grade for most of them (84%). Patients with face papules and patients who were in the group of nail, limb, and flexural involvement had significantly lower HRQOL (p-value 0.03). We found that FFA negatively impacts HRQOL, which was more pronounced in patients with involvement of other ostensible areas.

Frontal Fibrosing Alopecia: A Histopathological Comparison of the Frontal Hairline with Normal-Appearing Scalp.

Frontal fibrosing alopecia is characterized by the presence of a lymphocytic inflammatory infiltrate around the upper follicle and by perifollicular fibrosis, which results in the destruction of the hair follicle. Recent reports have also found the presence of those findings in clinically unaffected areas. The aim of this report is to perform a deeper analysis of the histopathological features of this apparently unaffected scalp. A cross-sectional study including 52 women with frontal fibrosing alopecia was performed. Two areas were biopsied: the frontal hairline and a normal-appearing scalp area. Sebaceous glands were reduced/absent in 80.8% of the frontal hairline samples compared to 42.3% of the “healthy scalp” samples (p = 0.001). Inflammatory infiltrate was observed in 92.3% of patients in the frontal hairline and in 86.5% of them in the “healthy scalp” area (p = 0.508), although the severity was higher in the former (p = 0.013). Follicular epithelium changes were seen in 70.6% of the frontal hairline biopsies compared to 48.1% of the “healthy scalp” biopsies (p = 0.012). Fibrous tissular changes were noted in 80.8% and 53.8% of the frontal hairline and “healthy scalp” biopsies, respectively (p = 0.003). In conclusion, the histopathological features of frontal fibrosing alopecia are shared by both affected and clinically unaffected areas.

Primary cicatricial alopecias are characterized by dysregulation of shared gene expression pathways.

The primary forms of cicatricial (scarring) alopecia (PCA) are a group of inflammatory, irreversible hair loss disorders characterized by immune cell infiltrates targeting hair follicles (HFs). Lichen planopilaris (LPP), frontal fibrosing alopecia (FFA), and centrifugal cicatricial alopecia (CCCA) are among the main subtypes of PCAs. The pathogenesis of the different types of PCAs are poorly understood, and current treatment regimens yield inconsistent and unsatisfactory results. We performed high-throughput RNA-sequencing on scalp biopsies of a large cohort PCA patients to develop gene expression-based signatures, trained into machine-learning-based predictive models and pathways associated with dysregulated gene expression. We performed morphological and cytokine analysis to define the immune cell populations found in PCA subtypes. We identified a common PCA gene signature that was shared between LPP, FFA, and CCCA, which revealed a significant over-representation of mast cell (MC) genes, as well as downregulation of cholesterogenic pathways and upregulation of fibrosis and immune signaling genes. Immunohistological analyses revealed an increased presence of MCs in PCAs lesions. Our gene expression analyses revealed common pathways associated with PCAs, with a strong association with MCs. The indistinguishable differences in gene expression profiles and immune cell signatures between LPP, FFA, and CCCA suggest that similar treatment regimens may be effective in treating these irreversible forms of hair loss.

BH09: Frontal fibrosing alopecia in men: is it any different?

BH09: Frontal fibrosing alopecia in men: is it any different?

BH06: Clinical trial of combination therapy with oral hydroxychloroquine and topical tacrolimus versus oral finasteride and topical tacrolimus in frontal fibrosing alopecia

BH06: Clinical trial of combination therapy with oral hydroxychloroquine and topical tacrolimus versus oral finasteride and topical tacrolimus in frontal fibrosing alopecia

BH13: Scarring alopecia affecting a congenital melanocytic naevus in a patient with frontal fibrosing alopecia

BH13: Scarring alopecia affecting a congenital melanocytic naevus in a patient with frontal fibrosing alopecia

Male Frontal Fibrosing Alopecia with Generalized Body Hair Loss.

Male Frontal Fibrosing Alopecia with Generalized Body Hair Loss.

BH12: Frontal fibrosing alopecia affecting the glabella and lower forehead without scalp involvement

BH12: Frontal fibrosing alopecia affecting the glabella and lower forehead without scalp involvement

BH10: Connecting the dots: facial papules as an early sign of early frontal fibrosing alopecia

BH10: Connecting the dots: facial papules as an early sign of early frontal fibrosing alopecia

Algorithm proposal for hair transplantation in fibrosing alopecia pattern distributidon.

Fibrosing alopecia pattern distribution (FAPD) is a recently described disease, wherein the clinical, trichoscopic, and histologic characteristics of non-scarring alopecia, such as androgenic alopecia, and lichenoid inflammatory cicatricial alopecia are reported. The lack of uniformity in the diagnostic criteria can result in FAPD overdiagnosis. The characteristic findings of loss of follicular openings on trichoscopy and fibrosis on histopathology are crucial, as they are necessary to diagnose cicatricial inflammatory lichenoid alopecias. ÂHair transplantation in FAPD can be controversial. The scarce publications in this realm do not reach a clear consensus in favor or against the surgical approach. Thus, the presence of histological lichenoid inflammatory infiltrates could make this therapeutic option less suitable. There have been few reports on hair transplantation in other lymphocytic lichenoid inflammatory alopecias, such as lichen planus pilaris (LPP) and frontal fibrosing alopecia (FFA) ÂBased on those data, an algorithm for the indication of hair transplantation in FAPD is proposed. The algorithm optimizes the results of the treatment and achieves the greatest coverage of the alopecic area.

Immune-mediated alopecias and their mechanobiological aspects.

Alopecia is a non-specific term for hair loss clinically diagnosed by the hair loss pattern and histological analysis of patient scalp biopsies. The immune-mediated alopecia subtypes, including alopecia areata, lichen planopilaris, frontal fibrosing alopecia, and central centrifugal cicatricial alopecia, are common, significant forms of alopecia subtypes. For example, alopecia areata is the most common autoimmune disease with a lifetime incidence of approximately 2% of the world's population. In this perspective, we discuss major results from studies of immune-mediated alopecia subtypes. These studies suggest the key event in disease onset as the collapse in immune privilege, which alters the hair follicle microenvironment, e.g., upregulation of major histocompatibility complex molecules and increase of cytokine production, and results in immune cell infiltration, inflammatory responses, and damage of hair follicles. We note that previous studies have established that the hair follicle has a complex mechanical microenvironment, which may regulate the function of not only tissue cells but also immune cell infiltrates. This suggests a potential for mechanobiology to contribute to alopecia research by adding new methods, new approaches, and new ways of thinking, which is missing in the existing literature. To fill this a gap in the alopecia research space, we develop a mechanobiological hypothesis that alterations in the hair follicle microenvironment, specifically in the mechanically responsive tissues and cells, partially due to loss of immune privilege, may be contributors to disease pathology. We further focus our discussion on the potential for applying mechanoimmunology to the study of T cell infiltrates in the hair follicle, as they are considered primary contributors to alopecia pathology. To establish the connection between the mechanoimmunological hypothesis and immune-mediated alopecia subtypes, we discuss what is known about the role of T cells in immune-mediated alopecia subtypes, using the most extensively studied AA as our model.

Trichoscopy-Derived Hairline Recession Equivalent in Monitoring Frontal Fibrosing Alopecia

Introduction: Frontal fibrosing alopecia (FFA) is a relatively recently described scarring hair loss condition. Frontal hair recession is observed in a vast majority of patients; other scalp areas may be included. Assessment of hair loss progression in FFA remains challenging mainly due to difficulties in unambiguous determination of the hairline. Various patterns of scarring and subtle progression rate are among factors which make naked-eye observations of limited use. Methods: Trichoscopy of the frontal hairline with hair-to-hair matching was conducted in patients with FFA patients with disease progression and clinically stable hairline. Hair loss was assessed based on analysis of trichoscopy-derived follicular maps. A relative hair density loss was calculated, and the hairline recession equivalent (HRE) was proposed as a novel hair loss progression measure. Results: Two patterns of hair loss were observed: one with significant decrease of hair density within a width of 1 mm and one with diffuse loss within a width of 10 mm. Conclusion: The hair density profile may be a useful tool to characterize different disease progression patterns. The HRE is potentially a very accurate and sensitive parameter to quantify local hair loss progression in FFA.

Vitamin D status in patients with frontal fibrosing alopecia: A retrospective study

Frontal fibrosing alopecia (FFA) is a primary lymphocytic cicatricial alopecia characterized by the recession of the frontal hair line. The pathogenesis is complex and multifactorial, with hormonal, environmental, and genetic factors implicated. Facial sunscreen products have been suggested as possible external etiologic contributors, and avoidance is recommended by some hair specialists as part of the treatment1,2; nevertheless, this theory requires further research to substantiate. Although rigorous photoprotection can affect vitamin D status, the use of facial sunscreen alone is not associated with its deficiency.

Frontal fibrosing alopecia: An overview

Frontal fibrosing alopecia (FFA) is a primary progressive cicatricial alopecia of the frontal, temporal, or frontotemporal scalp. In FFA, hairline recession, scalp pruritus, perifollicular erythema, and eyebrow loss are common at presentation. At present, there are no evidence-based treatment guidelines for FFA; hence, adopted modalities of treatment vary among clinicians. This review is an overview of the disease characteristics and the available therapeutic options in FFA.

Frontal fibrosing alopecia-update

The number of patients presenting with frontal fibrosing alopecia (FAA) is increasing not only in hair clinics. The recognition of the peculiar clinical pattern and associated symptoms is an important prerequisite to ensure adequate counseling and therapeutic management of the patients. Experimental studies and arange of case series give first insights into the pathogenesis, possible trigger factors, clinical course of disease and treatment options. The clinical spectrum of FFA extends beyond the typical recession of the frontal hair line initially observed in postmenopausal women. Younger women, men and rarely adolescents may also be affected. Band-like extension to the occiput, diffuse bitemporal hair thinning, eyebrow and body hair involvement as well as facial papules are part of the clinical spectrum. Similar to lichen planopilaris, inflammation and fibrosis with involvement of the stem cell region result in permanent loss of hair follicles. Which additional factors contribute to the characteristic pattern remains to be elucidated. Currently, therapeutic management largely relies on anti-inflammatory treatment with combined topical, intralesional and systemic administration depending on disease activity. The chronic progressive course, sometimes even in the absence of pronounced inflammation remains achallenge for both the affected individuals and the treating physicians. Controlled studies are required to develop evidence-based recommendations and to explore novel treatment strategies.

Optimal use of topical minoxidil in management of female pattern hair loss in India: an expert opinion

<p>Female pattern hair loss (FPHL) is a common cause of hair loss and is associated with a reduction in quality of life and psychological morbidity. It is characterised by nonscarring progressive thinning of hair with gradual reduction in the number of hairs, with prevalence increasing with advancing age. A differential diagnosis of FPHL includes conditions like chronic telogen effluvium, diffuse alopecia areata, and some cases of scarring alopecia such as frontal fibrosing alopecia. A comprehensive history and thorough clinical examination are essential in establishing the diagnosis of FPHL. Additionally, dermoscopy is a valuable tool for appropriate diagnosis, specifically in early stages of the disease. Due to the chronic course and progressive nature of FPHL, long-term management is essential for sustained effects. Medical treatment with minoxidil remains the mainstay treatment for FPHL. Other therapeutic modalities include topical therapies like biomimetic peptides, systemic therapies like oral anti-androgen drugs such as finasteride and spironolactone as well as oral minoxidil in selected cases. Dermatosurgical procedures like platelet rich plasma, microneedling, low level laser and hair transplantation have been used. The role of diet has also been debated. The current article provides an overview on the optimal use of topical minoxidil for management of FPHL in Indian clinical practice.</p>

Treatment of lichen planopilaris with baricitinib: A retrospective study

To the Editor: Lichen planopilaris (LPP) is a primary lymphocytic cicatricial alopecia.1 Frontal fibrosing alopecia (FFA) is considered a clinical variant of LPP.2 Limited evidence supports the therapeutic potential of tofacitinib, a Janus kinase (JAK)-1/3 inhibitor, for the treatment of recalcitrant LPP.3 The aim of our study was to evaluate the efficacy of baricitinib, a JAK-1/2 inhibitor, for the treatment of LPP.4

Standardizing the clinical and dermatoscopic exam for patients with afro‐textured hair and scarring alopecia: A scoping review and clinical guide

AbstractAlopecia is one of the most common reasons for a dermatology visit among Black patients. Patients with concomitant afro‐textured hair and scarring alopecias are often subjected to delays in diagnosis and treatment. Race‐discordant physicians may find the examination of scarring alopecias in ethnic hair to be daunting. Herein we present a standardized approach to evaluating the hair and scalp in afro‐textured alopecia patients in the hopes of providing a framework and guide for the proper clinical assessment of these patients. This guide focuses on common scarring alopecias specific to this ethnic population including traction alopecia, central centrifugal alopecia, frontal fibrosing alopecia and lichen planopilaris.

Allergic contact dermatitis from shellac in an ecological hair spray occurring in a patient with frontal fibrosing alopecia.

Allergic contact dermatitis from shellac in an ecological hair spray occurring in a patient with frontal fibrosing alopecia.