Review of clinical and demographic features of frontal fibrosing alopecia

Abstract

Aim: Frontal fibrosing alopecia (FFA) is a progressive scarring alopecia that occurs on the frontotemporal area. The ethiopathogenesis of FFA is still unclear. Genetic predisposition, hormonal and environmental factors, and the use of personal care products have been put forward as etiological factors. Our aim was to evaluate the clinical and demographical features of FFA patients retrospectively during a two-year follow-up period.

Methods: Patients who admitted to our dermatology out-patient clinic between January 2016 and January 2018 were included in the study. Diagnosis was made histologically or based on the typical clinical presentation (ear to ear hair loss). Age at first presentation and onset of FFA, relevant medical comorbidities, family history, menopause status, clinical features, and medical therapies administered were recorded. 

Results: All the patients were female and post-menopausal. Seven patients (87.75%) had hair loss on the eyebrows. Lonely hairs were observed in five patients (62.5%). Depression of frontal veins was observed in two patients (25%). Perifollicular erythema was observed in three patients (37.5%), and perifollicular scale was observed in four patients (50%). One of the patients (12.25%) exhibited a doll hair line. Two patients (25%) had early menopause history. The mean age of onset for graying hair was 30.87±11.39. Three patients (37.5%) had a history of premature hair graying. All the patients dyed their hair, and the mean age of hair dyeing was 31.5±10.50.

Conclusion: Perifollicular erythema and perifollicular scaling are important trichoscopic features of FFA. Environmental factors, autoimmune processes, and hormonal factors play a role in the development of FFA in genetically predisposed individuals. Premature hair graying and/or use of hair dyes (especially at early ages) can be a triggering or etiopathogenic factor for FFA.