Postmenopausal Frontal Fibrosing Alopecia Research Articles

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).

Expression of Snail1 in the fibrotic dermis of postmenopausal frontal fibrosing alopecia: possible involvement of an epithelial-mesenchymal transition and a review of the Japanese patients

British Journal of DermatologyVolume 162, Issue 5 p. 1152-1154 Expression of Snail1 in the fibrotic dermis of postmenopausal frontal fibrosing alopecia: possible involvement of an epithelial–mesenchymal transition and a review of the Japanese patients M. Nakamura, M. Nakamura Department of Dermatology,University of Occupational and Environmental Health,1-1 Iseigaoka, Yahatanishi-ku,Kitakyushu 807-8555, Japan E-mail: motonaka@med.uoeh-u.ac.jpSearch for more papers by this authorY. Tokura, Y. Tokura Department of Dermatology,University of Occupational and Environmental Health,1-1 Iseigaoka, Yahatanishi-ku,Kitakyushu 807-8555, Japan E-mail: motonaka@med.uoeh-u.ac.jpSearch for more papers by this author M. Nakamura, M. Nakamura Department of Dermatology,University of Occupational and Environmental Health,1-1 Iseigaoka, Yahatanishi-ku,Kitakyushu 807-8555, Japan E-mail: motonaka@med.uoeh-u.ac.jpSearch for more papers by this authorY. Tokura, Y. Tokura Department of Dermatology,University of Occupational and Environmental Health,1-1 Iseigaoka, Yahatanishi-ku,Kitakyushu 807-8555, Japan E-mail: motonaka@med.uoeh-u.ac.jpSearch for more papers by this author First published: 19 April 2010 https://doi.org/10.1111/j.1365-2133.2010.09682.xCitations: 19 Conflicts of interest: none declared. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume162, Issue5May 2010Pages 1152-1154 RelatedInformation

Treatment of postmenopausal frontal fibrosing alopecia with oral dutasteride

Treatment of postmenopausal frontal fibrosing alopecia with oral dutasteride

Postmenopausal frontal fibrosing alopecia in a Japanese woman with Sjögren's syndrome

Postmenopausal frontal fibrosing alopecia (PFFA) is a rare alopecia that develops in the frontoparietal scalp of postmenopausal women. Etiology of PFFA is unknown. Most of cases of PFFA have been reported in European and North American countries. Herein, we report a Japanese case of PFFA associated with Sjögren's syndrome. A 66-year-old woman had had slowly progressive, band-like, scarring alopecia on her frontoparietal scalp. Hair follicles on the margin showed follicular keratosis. Histologically, fibrosis and lymphocytic infiltration were mild. This case suggests that PFFA may show mild inflammatory reaction and mild fibrosis in Japanese women. The association with immunological disorders including Sjögren's syndrome should be studied further.

Did the Duchess of Urbino have Frontal Fibrosing Alopecia?

temporofrontoparietal hairline, and perhaps alopecia of both eyebrows, seen most clearly on the brow line. A contemporary bust of the Duchess at the Barguello Museum, also in Florence (Figure 2), would seem to confirm this impression as it bears a similar appearance. Arguments against PFFA include, primarily, her very young and definitely premenopausal age. However, this form of alopecia has occasionally been seen before the menopause4,5,7 and rare cases have even been known in men.8 Whatever the truth may be, this portrait presents us with a work of delicate beauty—where the jewels, brocades, and Throughout the history of art, painters have attempted to reflect both the beauty and imperfections of the human form on their canvases with greater or lesser success. There are “representations” of many skin diseases within works of art. In the absence of the complementary evidence needed to confirm clinical diagnosis, we must rely on astute observation alone to provide the foundation for our suspicions. Piero della Francesca’s painting The Duke and Duchess of Urbino hangs in Room 7, the early Renaissance section, of the Uffizi Gallery. The work consists of a pair of portraits depicting Federico de Montefeltro, Duke of Urbino, and his wife Battista Sforza (Figure 1). Our attention was drawn to the appearance of the Duchess, with a receding frontotemporoparietal hairline reminiscent of postmenopausal frontal fibrosing alopecia (PFFA). PFFA, described in 1994 by Kossard,1 mostly affects women aged between 49 and 83 years-old (mean, 64 years) and is characterized by a symmetrical recession of the frontotemporal hairline, causing a very characteristic band of pallid and uniform scarring alopecia. Associated alopecia of the eyebrows occurs in 62% of cases, and, less frequently, axillary alopecia. Histological findings vary with the developmental stage of the illness. Initially, there is lichenoid infiltrate in the upper part of the follicle that disappears as the illness advances and scarring alopecia sets in. Examination of the areas of alopecia reveals an absence of follicular orifices and, in some cases, follicular hyperkeratosis and perifollicular erythema.2-5 Battista Sforza, daughter of Alexander Sforza, Lord of Pesaro, was born in January 1446 and died aged 26 years old on July 6, 1472. The portrait of the Duke and Duchess of Urbino—the double portrait of Federico de Montefeltro and Battista Sforza we are looking at today—was completed after 1469, the year when Piero della Francesca first came to Urbino—a city where he painted other works including the Flagellation of Christ, the Senigallia Madonna, and the Madonna and Child with Saints. The portrait is a diptych showing Battista Sforza in profile, against the background of a landscape that possibly depicts the fields around Urbino. The Duchess has a curiously pale skin tone that some specialists have interpreted an indication that the portrait was commissioned posthumously.6 But could the Duchess have suffered from frontal fibrosing alopecia? Her appearance would seem to imply this: a band of alopecia producing a characteristic receding Did the Duchess of Urbino have Frontal Fibrosing Alopecia?

Frontal fibrosing alopecia: a survey in 16 patients

Postmenopausal frontal fibrosing alopecia (PFFA) was described by Kossard et al. as a progressive recession of the frontal hairline affecting particularly postmenopausal women. Further cases of PFFA have been reported to date, all of them considering it as a variant of lichen planopilaris on the basis of its clinical, histological and immunohistochemical features. To describe clinical features, and response to treatment of 16 cases of frontal fibrosing alopecia diagnosed at our department in the last 6 years. In addition to clinical data, biopsies and laboratory tests (antinuclear antibodies, sex hormones, thyroid hormones) were performed in order to rule out other causes of scarring alopecia. Patients were treated with intralesional corticosteroids, finasteride, and minoxidil, depending on the stage of the disease and association to androgenetic alopecia. All patients presented progressive alopecia localized to the frontal and temporal hairlines. Eight patients (50%) had loss of eyebrows, and six patients (37.5%) had axillar alopecia. Ages ranged from 45 to 79. Three of these women were premenopausal. Androgenetic alopecia was evident in seven patients (43.8%). All patients biopsied showed perifollicular lymphocitic infiltrate with lamelar fibrosis limited to the upper portions of the follicle. The progression of the condition stopped in most patients after a variable period on treatment. When treatment was abandoned the alopecia progressed to 'clown alopecia' appearance. Cases of Kossard's type scarring alopecia affecting premenopausal women made us consider that this condition is not exclusive of postmenopausal women. Differential diagnosis should take into account conditions like female androgenetic alopecia, fibrosing alopecia in a pattern distribution, alopecia areata, and chronic lupus erythematosus. Except for the pattern of alopecia, lichen planopilaris and frontal fibrosing alopecia are indistinguishable, thus the latter is included as a variant of lichen planopilaris. Although the disease tends to spontaneous stabilization, intralesional and topical corticosteroids, and anti-androgens may stop the progression of the disease and improve the female androgenetic alopecia that usually is associated to FFA.

Three cases of postmenopausal frontal fibrosing alopecia

Three cases of postmenopausal frontal fibrosing alopecia

Postmenopausal frontal fibrosing alopecia

Postmenopausal frontal fibrosing alopecia

Postmenopausal frontal fibrosing alopecia. Scarring alopecia in a pattern distribution

Postmenopausal frontal fibrosing alopecia. Scarring alopecia in a pattern distribution

Postmenopausal Frontal Fibrosing Alopecia

Recession of the frontal hairline is a common event in postmenopausal women. This has been shown not to be a marker of gross androgenization, and is usually a progressive nonscarring alopecia. Six postmenopausal women, who developed a progressive frontal scarring alopecia, were studied and their clinical and laboratory data, as well as the results of scalp biopsy specimens in all six patients, were analyzed and compared with recognized forms of scarring alopecia and recently described findings in androgenetic alopecia. The six postmenopausal women developed a progressive frontal hairline recession that was associated with perifollicular erythema within the marginal hairline, producing a frontal fibrosing alopecia extending to the temporal and parietal hair margins. Scalp biopsy specimens from the frontal hair margin showed perifollicular fibrosis and lymphocytic inflammation concentrated around the isthmus and infundibular areas of the follicles. Immunophenotyping of the lymphocytes showed a dominance of activated T-helper cells. Clinical review of all six cases showed a progressive marginal alopecia without the typical multifocal areas of involvement seen in lichen planopilaris or pseudopelade. None of the patients had mucous membrane or skin lesions typical of lichen planus. Hormonal studies, in five patients, showed no elevated androgen abnormalities. Progressive frontal recession in postmenopausal women may show clinical features of a fibrosing alopecia. The histologic findings are indistinguishable from those seen in lichen planopilaris. However, the absence of associated lesions of lichen planus in all six women raises the possibility that this mode of follicular destruction represents a reaction pattern triggered by the events underlying postmenopausal frontal hairline recession.