Facial Plast Surg 2018; 34(01): 088-094
DOI: 10.1055/s-0037-1615281
Rapid Communication
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Frontal Fibrosing Alopecia: A Retrospective Analysis of 72 Patients from a German Academic Center

Markus V. Heppt
1   Department of Dermatology and Allergy, Ludwig-Maximilian-University Munich, Munich, Germany
,
Valerie Letulé
1   Department of Dermatology and Allergy, Ludwig-Maximilian-University Munich, Munich, Germany
,
Ieva Laniauskaite
2   Centre of Dermatovenereology, Vilnius University, Vilnius, Lithuania
,
Markus Reinholz
1   Department of Dermatology and Allergy, Ludwig-Maximilian-University Munich, Munich, Germany
,
Julia K. Tietze
1   Department of Dermatology and Allergy, Ludwig-Maximilian-University Munich, Munich, Germany
,
Hans Wolff
1   Department of Dermatology and Allergy, Ludwig-Maximilian-University Munich, Munich, Germany
,
Thomas Ruzicka
1   Department of Dermatology and Allergy, Ludwig-Maximilian-University Munich, Munich, Germany
,
Elke C. Sattler
1   Department of Dermatology and Allergy, Ludwig-Maximilian-University Munich, Munich, Germany
› Author Affiliations
Funding None.
Further Information

Publication History

Publication Date:
26 December 2017 (online)

Abstract

Frontal fibrosing alopecia (FFA) describes the scarring, band-like recession of the frontotemporal hairline. Treatment is difficult, and currently, no evidence-based therapy exists. The purpose of this study is to report clinical features and treatment responses in a large cohort of patients with FFA. The authors analyzed a series of 72 patients with a clinical or histologic diagnosis of FFA. A total of 70 patients were female (97.2%), and 2 were male (2.8%). In females, the first onset of FFA was postmenopausal in 81.4% (n = 57). Documented eyebrow loss was present in 61.1% (n = 44), whereas involvement of eyelashes and body hair was reported in only 4.2% (n = 3) and 5.6% (n = 4), respectively. Clinical symptoms were itching (40.3%, n = 29) and trichodynia (4.2%, n = 3) in the alopecic area. Virtually all patients were treated with topical high-potency steroids. Additional treatments were topical tacrolimus, systemic retinoids, and hydroxychloroquine. A total of 48 patients (66.7%) received a combination of high-potency steroids with topical pimecrolimus. In this subgroup, subjective improvement or disease stabilization was reported by 64.6% (n = 31), and the hairline was stabilized on average after 9 to 12 months of therapy. The combination therapy of topical high-potency steroids with pimecrolimus may be an effective and steroid-saving treatment for FFA.

 
  • References

  • 1 Kossard S. Postmenopausal frontal fibrosing alopecia. Scarring alopecia in a pattern distribution. Arch Dermatol 1994; 130 (06) 770-774
  • 2 Kossard S, Lee MS, Wilkinson B. Postmenopausal frontal fibrosing alopecia: a frontal variant of lichen planopilaris. J Am Acad Dermatol 1997; 36 (01) 59-66
  • 3 Camacho Martínez F, García-Hernández MJ, Mazuecos Blanca J. Postmenopausal frontal fibrosing alopecia. Br J Dermatol 1999; 140 (06) 1181-1182
  • 4 Vañó-Galván S, Molina-Ruiz AM, Serrano-Falcón C. , et al. Frontal fibrosing alopecia: a multicenter review of 355 patients. J Am Acad Dermatol 2014; 70 (04) 670-678
  • 5 Nusbaum BP, Nusbaum AG. Frontal fibrosing alopecia in a man: results of follicular unit test grafting. Dermatol Surg 2010; 36 (06) 959-962
  • 6 Tziotzios C, Fenton DA, Stefanato CM, McGrath JA. Familial frontal fibrosing alopecia. J Am Acad Dermatol 2015; 73 (01) e37
  • 7 Ladizinski B, Bazakas A, Selim MA, Olsen EA. Frontal fibrosing alopecia: a retrospective review of 19 patients seen at Duke University. J Am Acad Dermatol 2013; 68 (05) 749-755
  • 8 Samrao A, Chew AL, Price V. Frontal fibrosing alopecia: a clinical review of 36 patients. Br J Dermatol 2010; 163 (06) 1296-1300
  • 9 Ceballos C, Priego C, Méndez C, Hoffner MV, García-Hernández MJ, Camacho FM. Study of frontal hairline patterns in Spanish Caucasian women. Actas Dermosifiliogr 2013; 104 (04) 311-315
  • 10 Tziotzios C, Stefanato CM, Fenton DA, Simpson MA, McGrath JA. Frontal fibrosing alopecia: reflections and hypotheses on aetiology and pathogenesis. Exp Dermatol 2016; 25 (11) 847-852
  • 11 Chew AL, Bashir SJ, Wain EM, Fenton DA, Stefanato CM. Expanding the spectrum of frontal fibrosing alopecia: a unifying concept. J Am Acad Dermatol 2010; 63 (04) 653-660
  • 12 Miteva M, Tosti A. The follicular triad: a pathological clue to the diagnosis of early frontal fibrosing alopecia. Br J Dermatol 2012; 166 (02) 440-442
  • 13 Mirmirani P, Willey A, Headington JT, Stenn K, McCalmont TH, Price VH. Primary cicatricial alopecia: histopathologic findings do not distinguish clinical variants. J Am Acad Dermatol 2005; 52 (04) 637-643
  • 14 Stefanato CM. Histopathology of alopecia: a clinicopathological approach to diagnosis. Histopathology 2010; 56 (01) 24-38
  • 15 Rácz E, Gho C, Moorman PW, Noordhoek Hegt V, Neumann HA. Treatment of frontal fibrosing alopecia and lichen planopilaris: a systematic review. J Eur Acad Dermatol Venereol 2013; 27 (12) 1461-1470
  • 16 Tziotzios C, Fenton DA, Stefanato CM, McGrath JA. Finasteride is of uncertain utility in treating frontal fibrosing alopecia. J Am Acad Dermatol 2016; 74 (04) e73-e74
  • 17 Wollenberg A, Bieber T. Proactive therapy of atopic dermatitis--an emerging concept. Allergy 2009; 64 (02) 276-278
  • 18 Miteva M, Aber C, Torres F, Tosti A. Frontal fibrosing alopecia occurring on scalp vitiligo: report of four cases. Br J Dermatol 2011; 165 (02) 445-447
  • 19 Dlova NC, Jordaan HF, Skenjane A, Khoza N, Tosti A. Frontal fibrosing alopecia: a clinical review of 20 black patients from South Africa. Br J Dermatol 2013; 169 (04) 939-941
  • 20 Egan BM, Zhao Y, Axon RN. US trends in prevalence, awareness, treatment, and control of hypertension, 1988-2008. JAMA 2010; 303 (20) 2043-2050
  • 21 Walsh JP, Bremner AP, Feddema P, Leedman PJ, Brown SJ, O'Leary P. Thyrotropin and thyroid antibodies as predictors of hypothyroidism: a 13-year, longitudinal study of a community-based cohort using current immunoassay techniques. J Clin Endocrinol Metab 2010; 95 (03) 1095-1104
  • 22 Kajantie E, Phillips DI, Osmond C, Barker DJ, Forsén T, Eriksson JG. Spontaneous hypothyroidism in adult women is predicted by small body size at birth and during childhood. J Clin Endocrinol Metab 2006; 91 (12) 4953-4956
  • 23 Vaisse V, Matard B, Assouly P, Jouannique C, Reygagne P. Postmenopausal frontal fibrosing alopecia: 20 cases [in French]. Ann Dermatol Venereol 2003; 130 (6-7): 607-610
  • 24 Tosti A, Piraccini BM, Iorizzo M, Misciali C. Frontal fibrosing alopecia in postmenopausal women. J Am Acad Dermatol 2005; 52 (01) 55-60
  • 25 Moreno-Ramírez D, Camacho Martínez F. Frontal fibrosing alopecia: a survey in 16 patients. J Eur Acad Dermatol Venereol 2005; 19 (06) 700-705
  • 26 MacDonald A, Clark C, Holmes S. Frontal fibrosing alopecia: a review of 60 cases. J Am Acad Dermatol 2012; 67 (05) 955-961
  • 27 Tan KT, Messenger AG. Frontal fibrosing alopecia: clinical presentations and prognosis. Br J Dermatol 2009; 160 (01) 75-79
  • 28 Georgala S, Katoulis AC, Befon A, Danopoulou I, Georgala C. Treatment of postmenopausal frontal fibrosing alopecia with oral dutasteride. J Am Acad Dermatol 2009; 61 (01) 157-158
  • 29 Rallis E, Gregoriou S, Christofidou E, Rigopoulos D. Frontal fibrosing alopecia: to treat or not to treat?. J Cutan Med Surg 2010; 14 (04) 161-166