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J Eur Acad Dermatol Venereol. 2019 Feb;33(2):433-438. doi: 10.1111/jdv.15372. Epub 2018 Dec 13.

Frontal fibrosing alopecia: a case series of 65 patients seen in a single Italian centre.

Author information

1
Dermatology, Department of Specialized, Diagnostic and Experimental Medicine, University of Bologna, Bologna, Italy.

Abstract

BACKGROUND:

Frontal fibrosing alopecia (FFA) is increasing in prevalence worldwide and several series from different countries have been published, in order to detect possible causes of the disease outbreak.

OBJECTIVE:

To analyze the epidemiological, clinical and trichoscopic features of FFA seen in an Italian Dermatology Unit.

METHODS:

Clinical, trichoscopy, histopathology and medical details of all patients were compared with literature and general population data.

RESULTS:

From 2005 to 2017, we diagnosed FFA in 65 Caucasian females, with the number of diagnoses per year progressively rising. Premenopausal onset was detected in 21%. Frontal hair line recession was associated with parietal involvement in 80% of cases, occipital in 12.3% and eyebrows alopecia in 86.1%. In six cases, eyebrow alopecia preceded hair loss. Non-inflammatory facial papules were detected in 1/3 of the patients. Itching was reported by 2/3 of the patients and was indicative of disease progression. Trichoscopy showed empty follicles/yellow dots, absence of follicular ostia, mild follicular hyperkeratosis, perifollicular erythema and 'lonely hair'. Scalp lichen plano-pilaris was seen in 15 patients, female pattern hair loss in 22. Therapy included short-term treatment with systemic or intralesional corticosteroids followed by therapy with 5α-reductase inhibitors of hydroxychloroquine and topical drugs. Arrest of FFA progression was seen in 75% of the patients, while 16 experienced worsening of the hairline despite therapy.

CONCLUSIONS:

Frontal fibrosing alopecia not rarely starts before menopause, loss of the eyebrows can be the first sign of the disease, about 50% of the patients have other autoimmune conditions, FFA severity is not related to its duration, itching, follicular hyperkeratosis and erythema at trichoscopy are signs of disease progression, 25% of the patients show progression of hairline recession despite therapy.

PMID:
30472804
DOI:
10.1111/jdv.15372
[Indexed for MEDLINE]

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