Frontal fibrosing alopecia: A retrospective review of 19 patients seen at Duke University

• Published in: Journal of the American Academy of Dermatology 2013-05, Vol.68 (5), p.749-755
• Main Authors: Ladizinski, Barry, MD, Bazakas, Andrea, BS, Selim, M. Angelica, MD, Olsen, Elise A., MD
• Format: Article
• Language: English
• Subjects: 5-alpha Reductase Inhibitors - therapeutic use; Adult; Aged; Alopecia - drug therapy; Alopecia - pathology; Anti-Bacterial Agents - therapeutic use; Azasteroids - therapeutic use; cicatricial alopecia; Cicatrix - drug therapy; Cicatrix - pathology; Dermatology; Dutasteride; Enzyme Inhibitors - therapeutic use; Eyebrows - pathology; Female; Fibrosis; Forehead - blood supply; Forehead - pathology; frontal fibrosing alopecia; Hospitals, University; Humans; Hydroxychloroquine - therapeutic use; Immunosuppressive Agents; lichen planopilaris; Lichen Planus - drug therapy; Lichen Planus - pathology; Methotrexate - therapeutic use; Middle Aged; Minocycline - therapeutic use; Osteoporosis, Postmenopausal; Retrospective Studies; Scalp - blood supply; Scalp - pathology; scarring hair loss; Tacrolimus - therapeutic use; Treatment Outcome
• ISSN: 0190-9622; 1097-6787
• DOI: 10.1016/j.jaad.2012.09.043

Background Frontal fibrosing alopecia (FFA) is a type of scarring hair loss primarily observed in postmenopausal women and characterized by fronto-tempero-parietal hairline recession, perifollicular erythema, and loss of eyebrows. The incidence is unknown, but the number of women presenting with this condition has significantly increased in recent years. No effective therapy has been established. Objective The purpose of this study is to present pertinent demographic and clinical findings of patients with FFA seen at an academic hair loss clinic and their responses to various therapeutic interventions. Methods Patients seen at the Duke University Hair Disorders Research and Treatment Center, Durham, NC, between 2004 and 2011 who met FFA inclusion criteria and signed an informed consent form for participation in the Duke University Hair Disorders Research and Treatment Center database were included in this review. Results Nineteen female patients with FFA met our inclusion criteria, the majority of whom were white and postmenopausal. A number of treatments, including topical and intralesional steroids, antibiotics, and immunomodulators, were used with disappointing results in most patients. However, the majority of patients on dutasteride experienced disease stabilization. Limitations This was a retrospective review and outside clinic records were occasionally incomplete. Conclusions FFA is an increasingly common form of scarring hair loss, but the origin remains unknown. Without clear understanding of the pathogenesis and evolution of this condition, it is not surprising that treatments to date have been minimally or not effective. At our institution, dutasteride was most effective in halting disease progression, although no therapy was associated with significant hair regrowth.