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Seo HM, Oh SU, Kim S, Park JH, Kim JS. Dutasteride in the treatment of frontal fibrosing alopecia: Systematic review and meta-analysis. J Eur Acad Dermatol Venereol 2024; 38:1514-1521. [PMID: 38357767 DOI: 10.1111/jdv.19802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 11/13/2023] [Indexed: 02/16/2024]
Abstract
Frontal fibrosing alopecia (FFA) is a scarring alopecia with fronto-temporo-parietal hairline recession. Although no proven treatment for FFA exists, dutasteride has been suggested as a potential treatment option. We aimed to evaluate the therapeutic response of oral dutasteride in FFA patients. The identification and selection of studies were conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis 2020 criteria. To assess the risk of bias for each study, we used the Cochrane's risk of bias in non-randomized studies of interventions (ROBINS-I) assessment tool. A random effects model meta-analysis was performed. Estimated proportion of stabilization for eligible studies was calculated to evaluate the effectiveness of dutasteride for treating FFA. Among patients who achieved stabilization, subgroup analysis was conducted on those showing improvement. Seven studies including 366 patients who received oral dutasteride were identified. The estimated proportion of patients who experienced stabilization of FFA with oral dutasteride was 0.628 (95% CI: 0.398-0.859). In subgroup analyses of patients who experienced improvement, the estimated proportion of improvement was 0.356 (95% CI: 0.163-0.549). In this systematic review and meta-analysis, oral dutasteride revealed to be a good treatment option for disease stabilization or improvement in patients with FFA.
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Affiliation(s)
- Hyun-Min Seo
- Department of Dermatology, College of Medicine, Hanyang University, Hanyang University Guri Hospital, Guri-Si, Korea
- Hanyang Institute of Bioscience and Biotechnology, Hanyang University, Seoul, Korea
| | - Se Uk Oh
- Department of Dermatology, College of Medicine, Hanyang University, Hanyang University Guri Hospital, Guri-Si, Korea
| | - Sungyu Kim
- Department of Dermatology, College of Medicine, Hanyang University, Hanyang University Guri Hospital, Guri-Si, Korea
| | - Ji Hun Park
- Department of Dermatology, College of Medicine, Hanyang University, Hanyang University Guri Hospital, Guri-Si, Korea
| | - Joung Soo Kim
- Department of Dermatology, College of Medicine, Hanyang University, Hanyang University Guri Hospital, Guri-Si, Korea
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2
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Beyzaee AM, Babaei M, Ghoreishi B, Waśkiel-Burnat A, Rudnicka L, Starace M, Tosti A, Patil A, Sinclair R, Goldust M, Rahmatpour Rokni G. Isotretinoin as a promising option in the treatment of facial papules of frontal fibrosing alopecia. Int J Dermatol 2024. [PMID: 38991994 DOI: 10.1111/ijd.17356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Revised: 06/11/2024] [Accepted: 06/12/2024] [Indexed: 07/13/2024]
Abstract
Frontal fibrosing alopecia (FFA) is a primary cicatricial alopecia characterized by hairline recession, pruritus, and facial papules (FP). Various therapies are used to stabilize disease activity and induce remission. However, FP of FFA is resistant to treatment in many cases. In this review, we searched the PubMed and Google Scholar databases to screen the published literature on treatment options for FP in the context of FFA. Overall, 12 studies were included in this review. Available literature suggests a noticeable improvement in resistant-to-treatment FP in FFA patients with oral isotretinoin. The available evidence is limited and is derived from retrospective studies and case reports/series. Systemic isotretinoin can be considered a promising therapeutic regimen for treating resistant-to-treatment FP of FFA patients. However, more extensive, well-designed studies are necessary for confirmatory evidence.
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Affiliation(s)
| | - Mahsa Babaei
- Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | | | - Lidia Rudnicka
- Department of Dermatology, Medical University of Warsaw, Warsaw, Poland
| | - Michela Starace
- Division of Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Antonella Tosti
- Department of Dermatology and Cutaneous Surgery, University of Miami, Miller School of Medicine, Miami, Florida, USA
| | - Anant Patil
- Department of Pharmacology, Dr. DY Patil Medical College, Navi Mumbai, India
| | - Rodney Sinclair
- Department of Dermatology, University of Melbourne, Melbourne, Vic., Australia
| | - Mohamad Goldust
- Department of Dermatology, Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Ghasem Rahmatpour Rokni
- Faculty of Medicine, Department of Dermatology, Mazandaran University of Medical Sciences, Sari, Iran
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3
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Shahpar A, Nezhad NZ, Sahaf AS, Ahramiyanpour N. A review of isotretinoin in the treatment of frontal fibrosing alopecia. J Cosmet Dermatol 2024; 23:1956-1963. [PMID: 38433314 DOI: 10.1111/jocd.16245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 01/27/2024] [Accepted: 02/09/2024] [Indexed: 03/05/2024]
Abstract
INTRODUCTION Frontal fibrosing alopecia (FFA) is characterized by scarring alopecia of the frontotemporal scalp and facial papules. Isotretinoin is a vitamin A-derived retinoid discovered in 1955 and approved for treating nodulocystic acne. This drug can also affect facial papules and frontotemporal hair loss in patients with FFA. In this article, we conducted a review of the available studies investigating the use of oral isotretinoin for FFA treatment. Our study provides insights into the efficacy and safety of isotretinoin as a potential treatment option for FFA and highlights areas for future research. METHOD In this study, we aimed to investigate the potential advantages and disadvantages of isotretinoin as a treatment for FFA. To identify all relevant articles, we developed a comprehensive search strategy and conducted a thorough search of three major databases: PubMed, Embase, and Science Direct. We retrieved a total of 82 articles from the search results. Two independent reviewers then screened each of the 82 articles based on our inclusion and exclusion criteria, resulting in the identification of 15 articles that were deemed relevant to our study. RESULTS Across the 15 articles, 232 patients who suffered from FFA were involved. Nearly 90% of patients experienced a significant reduction of symptoms after receiving oral isotretinoin at 10-40 mg daily. We conclude that isotretinoin can positively affect facial papules and help suppress hair loss.
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Affiliation(s)
- Amirhossein Shahpar
- Gastrointestinal Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Nazanin Zeinali Nezhad
- Physiology Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran
| | - Akram-Sadat Sahaf
- Department of Dermatology, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Najmeh Ahramiyanpour
- Department of Dermatology, Bushehr University of Medical Sciences, Bushehr, Iran
- Pathology and Stem Cell Research Center, Bushehr University of Medical Sciences, Bushehr, Iran
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4
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Krzesłowska WJ, Woźniacka A. The Frontal Fibrosing Alopecia Treatment Dilemma. J Clin Med 2024; 13:2137. [PMID: 38610902 PMCID: PMC11012663 DOI: 10.3390/jcm13072137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 04/02/2024] [Accepted: 04/02/2024] [Indexed: 04/14/2024] Open
Abstract
Frontal fibrosing alopecia (FFA) is a type of cicatricial alopecia predominantly observed in postmenopausal women, with the incidence rising since its initial description in 1994. The exact etiopathogenesis of the disease has not been completely elucidated. FFA is characterized by an inflammatory process affecting the hair follicles of the fronto-temporal hairline, leading to its gradual recession. Eyebrows, particularly the lateral parts, may also be affected. Early diagnosis and an implementation of effective therapy to limit the inflammatory process are crucial in halting disease progression. Various treatment possibilities have been reported, including anti-inflammatory and immunosuppressive agents, as well as 5-alpha-reductase inhibitors, retinoids, and antimalarial agents. The use of phototherapy and surgical procedures has also been described. However, most available data have been obtained retrospectively, frequently consisting of descriptions of case reports or small case series, and not from randomized controlled trials. In addition, the etiopathogenesis of FFA remains unclear and its course unpredictable, occasionally being linked with spontaneous stabilization. Hence, no precise guidelines exist regarding treatment modalities. Therefore, the aims of this study were to provide a comprehensive review of the efficacy of existing therapeutic modalities for FFA and to highlight novel therapeutic options.
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Affiliation(s)
| | - Anna Woźniacka
- Department of Dermatology and Venereology, Medical University of Lodz, Hallera 1, 90-647 Lodz, Poland;
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5
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Ravipati A, Randolph M, Al-Salhi W, Tosti A. Use of Hydroxychloroquine in Hair Disorders. Skin Appendage Disord 2023; 9:416-422. [PMID: 38058539 PMCID: PMC10697765 DOI: 10.1159/000533583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 08/10/2023] [Indexed: 12/08/2023] Open
Abstract
Hydroxychloroquine (HCQ) is an antimalarial that is utilized to treat a range of dermatologic and autoimmune disorders. With its ability to alter immunologic mechanisms, it has been used to slow or halt the progression of hair loss in conditions secondary to autoimmune dysfunction. Lichen planopilaris (LPP), frontal fibrosing alopecia (FFA), and alopecia areata (AA) are hair disorders with underlying autoimmune components and no standardized treatment guidelines. We summarized the available literature on the use of HCQ to treat LPP, FFA, and AA. For all three conditions, HCQ showed variable efficacy from halted hair loss to no improvement. While patients did show success with HCQ treatment, there were no clear treatment patterns. Regimens ranged from HCQ monotherapy to combination treatments with other agents like steroids. Overall, HCQ should certainly be considered by clinicians as a treatment option for patient suffering from these hair disorders. While there is no standardized treatment, incorporation of HCQ should take into consideration individual patient characteristics, clinical judgment, and risks of side effects.
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Affiliation(s)
- Advaitaa Ravipati
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami School of Medicine, Miami, FL, USA
| | - Michael Randolph
- Department of Dermatology, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Waleed Al-Salhi
- Department of Dermatology, Majmaah University College of Medicine, Al-Majmaah, Saudi Arabia
| | - Antonella Tosti
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami School of Medicine, Miami, FL, USA
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Carmona-Rodríguez M, Moro-Bolado F, Romero-Aguilera G, Ruiz-Villaverde R, Carriel V. Frontal Fibrosing Alopecia: An Observational Single-Center Study of 306 Cases. Life (Basel) 2023; 13:1344. [PMID: 37374126 DOI: 10.3390/life13061344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 05/16/2023] [Accepted: 06/02/2023] [Indexed: 06/29/2023] Open
Abstract
(1) Background: Frontal fibrosing alopecia (FFA) is a scarring alopecia that predominantly affects postmenopausal women; (2) Methods: A retrospective, observational, single-center study was conducted in the Hospital General Universitario in Ciudad Real, Spain, including all patients diagnosed with FFA between 2010 and 2021; (3) Results: A total of 306 patients (296 women and 10 men) were included in our study. The mean age of onset was 59.5 years. The severity of this disease was evenly distributed between mild (147 patients) and severe (149 patients) forms. There was a positive, statistically significant, medium correlation between the severity of the disease and its time of progression. Moreover, hypothyroidism was present in 70 patients (22.9%) and classic signs of concomitant lichen planopilaris were observed in just 30 patients (9.8%), while other forms of lichen planus were uncommon. The estimated prevalence in our population is 0.15% and the incidence is 15.47 new cases per 100,000 inhabitants; (4) Conclusions: The time of progression was positively correlated with the severity of FFA. However, the presence of clinical signs, such as inflammatory trichoscopic signs, was not associated with the progression of this condition.
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Affiliation(s)
| | - Fernando Moro-Bolado
- Servicio de Dermatología, Hospital General Universitario, 13005 Ciudad Real, Spain
| | | | - Ricardo Ruiz-Villaverde
- Servicio de Dermatología, Hospital Universitario San Cecilio, 18016 Granada, Spain
- Instituto de Investigación Biosanitaria, ibs.GRANADA, 18016 Granada, Spain
| | - Víctor Carriel
- Instituto de Investigación Biosanitaria, ibs.GRANADA, 18016 Granada, Spain
- Departamento de Histología, Grupo de Ingeniería Tisular, Universidad de Granada, 18016 Granada, Spain
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7
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Kinoshita-Ise M, Fukuyama M, Ohyama M. Recent Advances in Understanding of the Etiopathogenesis, Diagnosis, and Management of Hair Loss Diseases. J Clin Med 2023; 12:jcm12093259. [PMID: 37176700 PMCID: PMC10179687 DOI: 10.3390/jcm12093259] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 04/26/2023] [Accepted: 04/29/2023] [Indexed: 05/15/2023] Open
Abstract
Hair-loss diseases comprise heterogenous conditions with respective pathophysiology and clinicopathological characteristics. Major breakthroughs in hair follicle biology and immunology have led to the elucidation of etiopathogenesis of non-scarring alopecia (e.g., alopecia areata, AA) and cicatricial alopecia (e.g., lichen planopilaris, LPP). High-throughput genetic analyses revealed molecular mechanism underlying the disease susceptibility of hair loss conditions, such as androgenetic alopecia (AGA) and female pattern hair loss (FPHL). Hair loss attracted public interest during the COVID-19 pandemic. The knowledge of hair loss diseases is robustly expanding and thus requires timely updates. In this review, the diagnostic and measurement methodologies applied to hair loss diseases are updated. Of note, novel criteria and classification/scoring systems published in the last decade are reviewed, highlighting their advantages over conventional ones. Emerging diagnostic techniques are itemized with clinical pearls enabling efficient utilization. Recent advances in understanding the etiopathogenesis and management for representative hair diseases, namely AGA, FPHL, AA, and major primary cicatricial alopecia, including LPP, are comprehensively summarized, focusing on causative factors, genetic predisposition, new disease entity, and novel therapeutic options. Lastly, the association between COVID-19 and hair loss is discussed to delineate telogen effluvium as the predominating pathomechanism accounting for this sequela.
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Affiliation(s)
- Misaki Kinoshita-Ise
- Department of Dermatology, Kyorin University Faculty of Medicine, Tokyo 181-8611, Japan
| | - Masahiro Fukuyama
- Department of Dermatology, Kyorin University Faculty of Medicine, Tokyo 181-8611, Japan
| | - Manabu Ohyama
- Department of Dermatology, Kyorin University Faculty of Medicine, Tokyo 181-8611, Japan
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8
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Treatment of Frontal Fibrosing Alopecia. Dermatol Ther 2023. [DOI: 10.1155/2023/3856674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
Introduction. Frontal fibrosing alopecia (FFA) is known as a lymphocytic primary cicatricial alopecia. The main characteristic of FFA is progressive frontotemporal hairline recession. The pathogenesis of FFA is not completely understood. Destructing the stem cells of the epithelial hair follicles causes permanent hair loss and seems to be the main cause of FFA. Studies have reported significantly decreased quality of life in patients with hair loss. On the other hand, late diagnosis and treatment of FFA can decrease the success rate of the treatment. In this regard, different topical and systemic therapies have been developed to resolve the symptoms; however, only a partial response to treatment is usually achieved. We conducted a systematic review of the literature to identify the effectiveness of the available treatment modalities used for FFA patients and the related outcomes. Methods. On April 2022, we made a wide systematic computer-assisted search of PubMed and Google Scholar databases, using “frontal fibrosing alopecia” and “treatment” keywords. We scanned 1,514 articles. All the studies concerning a therapeutic regimen for FFA were included. After removing duplicate studies, 50 studies containing the therapeutic regimen of 1,478 FFA patients were included in this review. Results. The 5-alpha-reductase inhibitors (oral finasteride/dutasteride) were the most used medications (usually prescribed as a combination therapy with other medications). Topical corticosteroids were the second commonly used medication for the treatment of FFA. Systemic corticosteroids seem to be ineffective in improving FFA progression. Oral isotretinoin (or alitretinoin) had the most promising effect on improving facial papules of FFA patients with a 92% rate of facial papule improvement. Conclusion. In our review, intralesional corticosteroid injection and 5-alpha-reductase inhibitors (finasteride/dutasteride) were reported as the most effective treatment modalities. Oral isotretinoin (or alitretinoin) is considered as the most promising treatment for improving facial papules in the context of FFA. However, it had minimal effects on hair regrowth or stabilization of hairline recession in FFA patients.
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9
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VASTARELLA M, CANTELLI M, NAPPA P, FABBROCINI G, OCAMPO-GARZA SS. Efficacy and safety of hydroxychloroquine for the management of lichen planopilaris in a real-life setting. Ital J Dermatol Venerol 2022; 157:296-297. [DOI: 10.23736/s2784-8671.21.07093-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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10
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[Frontal fibrosing alopecia-update]. Hautarzt 2022; 73:344-352. [PMID: 35394176 DOI: 10.1007/s00105-022-04983-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2022] [Indexed: 10/18/2022]
Abstract
The number of patients presenting with frontal fibrosing alopecia (FAA) is increasing not only in hair clinics. The recognition of the peculiar clinical pattern and associated symptoms is an important prerequisite to ensure adequate counseling and therapeutic management of the patients. Experimental studies and a range of case series give first insights into the pathogenesis, possible trigger factors, clinical course of disease and treatment options. The clinical spectrum of FFA extends beyond the typical recession of the frontal hair line initially observed in postmenopausal women. Younger women, men and rarely adolescents may also be affected. Band-like extension to the occiput, diffuse bitemporal hair thinning, eyebrow and body hair involvement as well as facial papules are part of the clinical spectrum. Similar to lichen planopilaris, inflammation and fibrosis with involvement of the stem cell region result in permanent loss of hair follicles. Which additional factors contribute to the characteristic pattern remains to be elucidated. Currently, therapeutic management largely relies on anti-inflammatory treatment with combined topical, intralesional and systemic administration depending on disease activity. The chronic progressive course, sometimes even in the absence of pronounced inflammation remains a challenge for both the affected individuals and the treating physicians. Controlled studies are required to develop evidence-based recommendations and to explore novel treatment strategies.
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11
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Murad A, Wolinska A, Bergfeld WF. Frontal fibrosing alopecia in breast cancer patients on aromatase‐inhibitor: 2 cases. J Eur Acad Dermatol Venereol 2022; 36:e470-e472. [DOI: 10.1111/jdv.17958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 01/19/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Aizuri Murad
- Departments of Dermatology and Histopathology Cleveland Clinic Foundation Ohio USA
- Departments of Dermatology and Histopathology Our Lady of Lordes Drogheda Ireland
- Departments of Dermatology and Histopathology UCD School of Medicine Dublin Ireland
| | - Anna Wolinska
- Departments of Dermatology and Histopathology Our Lady of Lordes Drogheda Ireland
| | - Wilma F. Bergfeld
- Departments of Dermatology and Histopathology Cleveland Clinic Foundation Ohio USA
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12
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Olsen EA, Harries M, Tosti A, Bergfeld W, Blume-Peytavi U, Callender V, Chasapi V, Correia O, Cotsarelis G, Dhurat R, Dlova N, Doche I, Enechukwu N, Grimalt R, Itami S, Hordinsky M, Khobzei K, Lee WS, Malakar S, Messenger A, McMichael A, Mirmirani P, Ovcharenko Y, Papanikou S, Pinto GM, Piraccini BM, Pirmez R, Reygagne P, Roberts J, Rudnicka L, Saceda-Corralo D, Shapiro J, Silyuk T, Sinclair R, Soares RO, Souissi A, Vogt A, Washenik K, Zlotogorski A, Canfield D, Vano-Galvan S. Guidelines for clinical trials of frontal fibrosing alopecia: consensus recommendations from the International FFA Cooperative Group (IFFACG). Br J Dermatol 2021; 185:1221-1231. [PMID: 34105768 DOI: 10.1111/bjd.20567] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Frontal fibrosing alopecia (FFA) has become one of the most common causes of cicatricial alopecia worldwide. However, there is a lack of clear aetiology and robust clinical trial evidence for the efficacy and safety of agents currently used for treatment. OBJECTIVES To enable data to be collected worldwide on FFA using common criteria and assessment methods. METHODS A multicentre, international group of experts in hair loss was convened by email to create consensus recommendations for clinical trials. Consensus was defined at > 90% agreement on each recommended part of these guidelines. RESULTS Standardized diagnostic criteria, severity rating, staging, and investigator and patient assessment of scalp hair loss and other clinical features of FFA were created. CONCLUSIONS These guidelines should allow the collection of reliable aggregate data on FFA and advance efforts in both clinical and basic research to close knowledge gaps in this condition.
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Affiliation(s)
- E A Olsen
- Duke University Medical Center, Durham, NC, USA
| | - M Harries
- University of Manchester, MAHSC and NIHR Manchester Biomedical Research Centre, Salford Royal NHS Foundation Trust, Salford, UK
| | - A Tosti
- University of Miami Miller School of Medicine, Miami, FL, USA
| | | | | | - V Callender
- Callender Dermatology & Cosmetic Center and Howard University College of Medicine, Washington, DC, USA
| | - V Chasapi
- Andreas Sygros Hospital, Athens, Greece
| | - O Correia
- Centro Dermatologia Epidermis, Porto, Portugal
| | - G Cotsarelis
- University of Pennsylvania, Philadelphia, PA, USA
| | - R Dhurat
- LTM Medical College & Hospital Sion, Mumbai, India
| | - N Dlova
- University of KwaZulu Natal, Durban, South Africa
| | - I Doche
- University of Sao Paulo Medical School, Sao Paulo, SP, Brazil
| | - N Enechukwu
- Nnamdi Azikiwe University Awka, Anambra State, Nigeria
| | - R Grimalt
- Universitat Internacional de Catalunya, Barcelona, Spain
| | - S Itami
- Oita University, Oita, Japan
| | - M Hordinsky
- University of Minnesota Medical School, Minneapolis, MN, USA
| | - K Khobzei
- Kyiv Medical University, Kyiv, Ukraine
| | - W-S Lee
- Yonsei University, Wonju College of Medicine, Wonju, Gangwon-do, Republic of Korea
| | - S Malakar
- Rita Skin Foundation, Kolkata, West Bengal, India
| | | | - A McMichael
- Wake Forest School of Medicine, Winston Salem, NC, USA
| | - P Mirmirani
- Kaiser Permanente Northern California, Vallejo, CA, USA
| | - Y Ovcharenko
- V.N. Karazin Kharkiv National University, Kharkiv, Ukraine
| | | | - G M Pinto
- University of Miami Miller School of Medicine, Miami, FL, USA
| | | | - R Pirmez
- Instituto de Dermatologia Professor Rubem David Azulay - Santa Casa da Misericórdia do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - P Reygagne
- Centre Sabouraud, Hôpital Saint Louis, Paris, France
| | - J Roberts
- Northwest Dermatology Institute, Portland, OR, USA
| | - L Rudnicka
- Medical University of Warsaw, Warsaw, Poland
| | - D Saceda-Corralo
- Ramón y Cajal Hospital, IRYCIS, University of Alcala, Madrid, Spain
| | - J Shapiro
- New York University Grossman School of Medicine, New York, NY, USA
| | - T Silyuk
- Hair Treatment and Transplantation Center Private Practice, Saint Petersburg, Russia
| | - R Sinclair
- University of Melbourne and Sinclair Dermatology, Melbourne, VIC, Australia
| | - R O Soares
- Cuf Descobertas Hospital, Lisbon, Portugal
| | - A Souissi
- Department of Dermatology, University of Tunis El Manar, Tunis, Tunisia
| | - A Vogt
- Charité-Universitaetsmedizin, Berlin, Germany
| | - K Washenik
- Bosley Medical Group, Beverly Hills, CA and New York University Grossman School of Medicine, New York, NY, USA
| | - A Zlotogorski
- Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - D Canfield
- Canfield Scientific, Inc, Parsippany, NJ, USA
| | - S Vano-Galvan
- Ramón y Cajal Hospital, IRYCIS, University of Alcala, Madrid, Spain
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13
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Frontal Fibrosing Alopecia: A Review. J Clin Med 2021; 10:jcm10091805. [PMID: 33919069 PMCID: PMC8122646 DOI: 10.3390/jcm10091805] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 04/14/2021] [Accepted: 04/17/2021] [Indexed: 12/19/2022] Open
Abstract
Frontal fibrosing alopecia is a scarring alopecia, the prevalence of which is increasing worldwide since its first description in 1994. The reason for this emerging epidemic may be a higher exposure to an unknown trigger, although its aethiology and pathogenesis still remain enigmatic. Clinical, trichoscopic, sonographic, and histopathologic findings are allowing clinicians to understand more aspects about this type of cicatricial alopecia. Several treatments have been used in frontal fibrosing alopecia, although the 5-alpha reductase inhibitors seem to be the most promising. The aim of this report is to provide a compilation about the published data regarding frontal fibrosing alopecia in a narrative review.
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14
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Moll I. Frontal fibrosierende Alopezie – Fallbeispiele und Review. AKTUELLE DERMATOLOGIE 2021. [DOI: 10.1055/a-1351-5678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
ZusammenfassungDie frontal fibrosierende Alopezie (FFA) ist eine vernarbende Alopezie, welche klinisch durch Regression des frontotemporalen Haaransatzes, disseminiert verbleibende Haare (lonely hairs) und Verlust der Brauen gekennzeichnet ist. Meist sind postmenopausale, seltener auch jüngere Frauen betroffen und gelegentlich auch Männer. Der Verlauf ist variabel, oft sehr langsam und unbeachtet. Auch Spontanremissionen sind häufig. Daher lässt sich die Inzidenz nur schätzen, jedoch ist sie wahrscheinlich zunehmend. Es werden dafür Umweltfaktoren, Sonnencremes, aber auch eine optimierte Awareness und Diagnostik diskutiert. Allerdings blieb die Pathogenese der lymphozytären Follikulitis bisher noch ungeklärt. Klinisch ist die Haut im betroffenen bandförmigen Bereich atroph und weißlich. In floriden Bereichen sind follikuläre Erytheme und Keratosen typisch. Nicht selten sind kleine, wenig erythematöse Papeln an Stirn und Wangen assoziiert („facial papules“). Evidenzbasierte Therapien existieren nicht. Lokal werden Steroide, Calcineurin-Inhibitoren oder Minoxidil angewendet, systemisch 5α-Reduktase-Hemmer, Hydroxychloroquin und Doxycyclin.
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Imhof R, Tolkachjov SN. Optimal Management of Frontal Fibrosing Alopecia: A Practical Guide. Clin Cosmet Investig Dermatol 2020; 13:897-910. [PMID: 33293846 PMCID: PMC7718862 DOI: 10.2147/ccid.s235980] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 11/02/2020] [Indexed: 01/06/2023]
Abstract
Frontal fibrosing alopecia (FFA) is a primary lymphocytic cicatricial alopecia that is often considered a clinical variant of lichen planopilaris (LPP) due to their shared histopathologic features. FFA is characterized by the recession of the frontal, temporal, or frontotemporal hairline; the clinical pattern is distinct and usually includes eyebrow hair loss, as well as other associated symptoms. Pruritus, facial papules, eyelash loss, body hair involvement, and trichodynia may also occur in addition to the frontotemporal recession and eyebrow loss classically seen. Early diagnosis and prompt treatment are critical as FFA is a progressive disorder that can result in permanent hair loss. FFA is challenging as patients may not present or be recognized until the disease has progressed. Additionally, there is currently no consensus or standard treatment regimen for FFA. While many different therapies have been reported as beneficial, there are a limited number of published guidelines for the treatment of FFA. This article is a review of the literature on treatment modalities for FFA and the objective is to offer a practical guide for clinicians on the evidence-based management options currently available in the literature.
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Affiliation(s)
- Reese Imhof
- Mayo Clinic Alix School of Medicine, Rochester, MN, USA
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Panchaprateep R, Ruxrungtham P, Chancheewa B, Asawanonda P. Clinical characteristics, trichoscopy, histopathology and treatment outcomes of frontal fibrosing alopecia in an Asian population: A retro-prospective cohort study. J Dermatol 2020; 47:1301-1311. [PMID: 32710515 DOI: 10.1111/1346-8138.15517] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 06/22/2020] [Indexed: 12/14/2022]
Abstract
Frontal fibrosing alopecia (FFA) is a distinctive lymphocytic scarring alopecia with rapid increase in prevalence. Most FFA series are retrospectively reported from Caucasians with only few from Asians. The objective of this study was to characterize the clinical, trichoscopic and histopathological findings as well as treatment outcomes. This was a retro-prospective cohort study of patients diagnosed with FFA from 1 January 2010 to 1 November 2019. All patients were asked to present for re-examination. Clinical, trichoscopic, histopathological and laboratory data were recorded. A questionnaire was used to investigate hair care, hairstyle and facial skin care compared with age-matched normal controls. Multivariate analysis was performed in order to clarify factors associated with severity. All 58 FFA patients were female, of whom 27.6% were premenopausal, 37.7% had a history of surgical menopause, 13.8% had thyroid diseases, 69% had eyebrow loss and 32.8% facial papules. On physical examination, 10.3% showed linear pattern, 46.6% diffuse pattern and 43.1% pseudo-fringe sign. Concomitant lichen planopilaris was found in 25.9%, lichen planus pigmentosus in 24.1% and female pattern hair loss in 48.3%. The most common trichoscopic characteristics in the frontal hairline were lack of follicular ostia (91.4%), perifollicular scales (79.3%) and perifollicular erythema (63.8%). Up to 90% of patients reported FFA as improved or stable after receiving antiandrogen (finasteride or dutasteride) or antimalarial with topical treatment. Multivariate analyses revealed that facial lentiginous macules and trichoscopic perifollicular erythema at the frontal area were FFA severity-associated factors. "Front puff" Thai hairstyle was associated with FFA, while sunscreens and other cosmetic products were not. In conclusion, diffuse and pseudo-fringe sign pattern are common in Asian FFA. The most common autoimmune systemic comorbidity is thyroid disease, while common concomitant dermatological diseases are female pattern hair loss, lichen planopilaris and lichen planus pigmentosus. Antiandrogens or antimalarial plus topical treatment are the most useful therapy.
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Affiliation(s)
- Ratchathorn Panchaprateep
- Division of Dermatology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Pariya Ruxrungtham
- Division of Dermatology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Bussabong Chancheewa
- Division of Dermatology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Pravit Asawanonda
- Division of Dermatology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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Abstract
Frontal fibrosing alopecia (FFA) is a patterned primary cicatricial alopecia that was first described in 1994. Once rare, the incidence of FFA has increased dramatically, representing the current most common cause of cicatricial alopecia worldwide. FFA typically begins in postmenopausal women with symmetrical, progressive recession of the frontotemporal hairline together with bilateral loss of the eyebrows. FFA has a distinctive clinical phenotype, which remains a challenge. The histology is identical to lichen planopilaris (LPP), but only a small number of patients have coincidental LPP, usually of the scalp. The vast majority of patients have no evidence of lichen planus elsewhere, and the symmetry and patterned nature of the hair loss are unusual for LPP. Familial cases of FFA are reported, and gene associations have been identified in population studies; however, the pathophysiology remains controversial. Without treatment, FFA is slowly progressive, and although many treatments have been prescribed, the response is often disappointing. We review the pathogenesis, epidemiology, clinical features, histology, and treatment of FFA.
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Affiliation(s)
| | | | - Bevin Bhoyrul
- Sinclair Dermatology, East Melbourne, Victoria, Australia
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18
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Effectiveness of dutasteride in a large series of patients with frontal fibrosing alopecia in real clinical practice. J Am Acad Dermatol 2020; 84:1285-1294. [PMID: 33038469 DOI: 10.1016/j.jaad.2020.09.093] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 09/16/2020] [Accepted: 09/30/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Dutasteride has been proposed as an effective therapy for frontal fibrosing alopecia (FFA). OBJECTIVES We sought to describe the therapeutic response to dutasteride and the most effective dosage in FFA compared with other therapeutic options or no treatment. METHODS This was a retrospective observational study including patients with FFA with a minimum follow-up of 12 months. Therapeutic response was evaluated according to the stabilization of the hairline recession. RESULTS A total of 224 patients (222 females) with a median follow-up of 24 months (range 12-108 months) were included. The stabilization rate for the frontal, right, and left temporal regions after 12 months was 62%, 64%, and 62% in the dutasteride group (n = 148), 60%, 35%, and 35% with other systemic therapies (n = 20), and 30%, 41%, and 38% without systemic treatment (n = 56; P = .000, .006, and .006, respectively). Stabilization showed a statistically significant association with an increasing dose of dutasteride (88%, 91%, and 84% with a weekly treatment of 5 or 7 doses of 0.5 mg [n = 32], P < .005). Dutasteride was well tolerated in all patients. LIMITATIONS Limitations included the observational and retrospective design. CONCLUSIONS Oral dutasteride was the most effective therapy with a dose-dependent response for FFA in real clinical practice compared with other systemic therapies or no systemic treatment.
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Pincelli TP, Heckman MG, Cochuyt JJ, Sluzevich JC. Valchlor ® in the Treatment of Lichen Planopilaris and Frontal Fibrosing Alopecia: A Single Arm, Open-label, Exploratory Study. Int J Trichology 2020; 12:220-226. [PMID: 33531744 PMCID: PMC7832166 DOI: 10.4103/ijt.ijt_16_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 07/19/2020] [Accepted: 07/23/2020] [Indexed: 01/06/2023] Open
Abstract
Background: Lichen Planopilaris (LPP) is a lymphocyte-mediated scarring alopecia that frequently is treatment resistance to both topical and systemic therapies. Aims and Objectives: The object of this pilot study was to assess the effectiveness of topical mechlorethamine 0.016% gel (Valchlor®) in decreasing disease activity in LPP and the related clinical variant frontal fibrosing alopecia (FAA). Methods: Twelve patients with biopsy-proven LPP/FAA who failed prior topical or systemic therapy with active disease were included. Participants applied mechlorethamine 0.016% gel to involved areas daily for 24 weeks. Outcome measures included LPP Activity Index (LPPAI) score, Physician Global Assessment (PGA) score, Dermatology Quality of Life Index (DQLI) score, and phototrichograms assessing follicular counts before and after six months of therapy. Results: LPP Activity Index (LPPAI) before and after treatment was significantly different (5.0 before treatment, 2.0 after treatment; p value=0.006). Mean follicular density and follicular units were unchanged during the treatment period. Conclusion: Treatment with mechlorethamine 0.016% gel for 24 weeks resulted in statistically significant improvement of LLP/FFA with no change in phototrichogram parameters. Treatment duration was limited by high rate of contact dermatitis. Further investigation to optimize dosing frequency and to assess the role of combination topical therapy is needed.
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Affiliation(s)
- Thais P Pincelli
- Department of Dermatology, Mayo Clinic, Jacksonville, Florida, USA
| | - Michael G Heckman
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, Florida, USA
| | - Jordan J Cochuyt
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, Florida, USA
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Halley-Stott RP, Adeola HA, Khumalo NP. Destruction of the stem cell Niche, Pathogenesis and Promising Treatment Targets for Primary Scarring Alopecias. Stem Cell Rev Rep 2020; 16:1105-1120. [PMID: 32789558 DOI: 10.1007/s12015-020-09985-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The Primary Scarring Alopecias are characterised by the irreversible destruction and fibrosis of hair follicles, leading to permanent and often disfiguring loss of hair. The pathophysiology of these diseases is not well understood. However, follicular-fibrosis and loss of the stem-cell niche appears to be a common theme. This review explores the pathogenesis of primary scarring alopecias, asking what happens to the stem cells of the hair follicle and how they may contribute to the progression of these diseases. Bulge-resident cells are lost (leading to loss of capacity for hair growth) from the follicle either by inflammatory-mediate apoptosis or through epigenetic reprogramming to assume a mesenchymal-like identity. What proportion of bulge cells is lost to which process is unknown and probably differs depending on the individual PCA and its specific inflammatory cell infiltrate. The formation of fibroblast-like cells from follicular stem cells may also mean that the cells of the bulge have a direct role in the pathogenesis. The identification of specific cells involved in the pathogenesis of these diseases could provide unique diagnostic and therapeutic opportunities to prevent disease progression by preventing EMT and specific pro-fibrotic signals.
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Affiliation(s)
- Richard P Halley-Stott
- Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory, Cape Town, South Africa.
| | - Henry A Adeola
- Hair and Skin Research Laboratory, Groote Schuur Hospital, Cape Town, South Africa
| | - Nonhlanhla P Khumalo
- Hair and Skin Research Laboratory, Groote Schuur Hospital, Cape Town, South Africa
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Larkin SC, Cantwell HM, Imhof RL, Torgerson RR, Tolkachjov SN. Lichen Planopilaris in Women: A Retrospective Review of 232 Women Seen at Mayo Clinic From 1992 to 2016. Mayo Clin Proc 2020; 95:1684-1695. [PMID: 32753140 DOI: 10.1016/j.mayocp.2020.02.028] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 02/06/2020] [Accepted: 02/10/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To characterize the clinicopathologic findings, comorbidities, and treatment outcomes of women with lichen planopilaris (LPP). METHOD In this retrospective review of women with LPP at Mayo Clinic from 1992 to 2016, we searched for scarring alopecia in all female patients aged 1 to 100 years from January 1, 1992, through December 31, 2016. Men were excluded from this study to more accurately determine the association of hormonal factors in LPP pathogenesis. Two hundred thirty-two patients were included as they met diagnostic criteria for LPP based on clinicopathologic correlation, with 217 having confirmatory biopsies. RESULTS We identified 232 women with LPP (mean age, 59.8 years). Of those, 92.7% (215) presented with hair loss; 23.7% (55) had preceding inflammation; 30.6% (71) had thyroid disease, including hypothyroidism (23.2%; 54); and 9.4% (22) had vitamin D deficiency. Incidence of depression and anxiety was 45.7% (106) and 41.8% (97), respectively. History of total abdominal hysterectomy/bilateral salpingo-oophorectomies and hormone replacement therapy was found in 16.8% (39) and 16.4% (38), respectively. Lichen planus at other body sites occurred in 16.4% (38) of patients; and 53.2% (123) had slowing of disease progression or disease stabilization, often requiring combination therapies. In those who achieved slowing or stabilization of disease, mean time to recurrence was 1.8 year. The mean time to remission was 1.1 year. CONCLUSION The typical LPP patient is a 60-year-old female with vertex scarring alopecia who presents with burning, erythema, inflammation, and scale. Almost half of patients will have comorbid autoimmunity. As previously reported, LPP is associated with thyroid disease. We also found higher rates of depression, anxiety, nutritional deficiencies, and skin cancer than reported in the general population.
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Affiliation(s)
| | | | - Reese L Imhof
- Mayo Clinic School of Medicine, Mayo Clinic, Rochester, MN
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Maldonado Cid P, Leis Dosil V, Garrido Gutiérrez C, Salinas Moreno S, Thuissard Vasallo I, Andreu Vázquez C, Díaz Díaz R. Alopecia frontal fibrosante: estudio retrospectivo de 75 pacientes. ACTAS DERMO-SIFILIOGRAFICAS 2020; 111:487-495. [DOI: 10.1016/j.ad.2020.03.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 03/03/2020] [Accepted: 03/26/2020] [Indexed: 12/19/2022] Open
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Maldonado Cid P, Leis Dosil V, Garrido Gutiérrez C, Salinas Moreno S, Thuissard Vasallo I, Andreu Vázquez C, Díaz Díaz R. Frontal Fibrosing Alopecia: A Retrospective Study of 75 Patients. ACTAS DERMO-SIFILIOGRAFICAS 2020. [DOI: 10.1016/j.adengl.2020.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Rudnicka L, Rokni GR, Lotti T, Wollina U, Fölster‐Holst R, Katsambas A, Goren A, Di Lernia VG, Rathod D, Mirabi A, Ghaffari A, Rajan A, Goldust M. Allergic contact dermatitis in patients with frontal fibrosing alopecia: An international multi‐center study. Dermatol Ther 2020; 33:e13560. [DOI: 10.1111/dth.13560] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 04/25/2020] [Accepted: 05/08/2020] [Indexed: 12/19/2022]
Affiliation(s)
- Lidia Rudnicka
- Department of Dermatology Medical University of Warsaw Warsaw Poland
| | - Ghasem R. Rokni
- Department of Dermatology Mazandaran University of Medical Sciences Sari Iran
| | | | - Uwe Wollina
- Department of Dermatology and Allergology Städtisches Klinikum Dresden, Academic Teaching Hospital of the Technical University of Dresden Dresden Germany
| | - Regina Fölster‐Holst
- Dermatologie, Venerologie und Allergologie Universitätsklinikum Schleswig‐Holstein Keil Germany
| | - Andreas Katsambas
- Department of Dermatology Andreas Syggros Hospital, University of Athens Athens Greece
| | - Andy Goren
- University of Studies Guglielmo Marconi Rome Italy
| | - Vito G. Di Lernia
- Dermatology Unit Department of Medical Specialties, Arcispedale Santa Maria Nuova, Azienda USL‐IRCCS di Reggio Emilia Reggio Emilia Italy
| | | | - Ali Mirabi
- Department of Dermatology Mazandaran University of Medical Sciences Sari Iran
| | - Anousheh Ghaffari
- Department of Dermatology Mazandaran University of Medical Sciences Sari Iran
| | - Aswath Rajan
- Department of Dermatology and Venereology Goa Medical College Goa India
| | - Mohamad Goldust
- Department of Dermatology University of Rome G. Marconi Rome Italy
- Department of Dermatology University Medical Center Mainz Mainz Germany
- Department of Dermatology University Hospital Basel Basel Switzerland
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Suchonwanit P, Pakornphadungsit K, Leerunyakul K, Khunkhet S, Sriphojanart T, Rojhirunsakool S. Frontal fibrosing alopecia in Asians: a retrospective clinical study. Int J Dermatol 2019; 59:184-190. [DOI: 10.1111/ijd.14672] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 08/26/2019] [Accepted: 09/09/2019] [Indexed: 12/19/2022]
Affiliation(s)
- Poonkiat Suchonwanit
- Division of Dermatology Faculty of Medicine Ramathibodi Hospital Mahidol University Bangkok Thailands
| | - Kallapan Pakornphadungsit
- Division of Dermatology Faculty of Medicine Ramathibodi Hospital Mahidol University Bangkok Thailands
| | - Kanchana Leerunyakul
- Division of Dermatology Faculty of Medicine Ramathibodi Hospital Mahidol University Bangkok Thailands
| | - Saranya Khunkhet
- Division of Dermatology Faculty of Medicine Ramathibodi Hospital Mahidol University Bangkok Thailands
| | - Tueboon Sriphojanart
- Division of Dermatology Faculty of Medicine Ramathibodi Hospital Mahidol University Bangkok Thailands
| | - Salinee Rojhirunsakool
- Division of Dermatology Faculty of Medicine Ramathibodi Hospital Mahidol University Bangkok Thailands
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Olsen EA, Whiting DA. Focal atrichia: A diagnostic clue in female pattern hair loss. J Am Acad Dermatol 2019; 80:1538-1543.e1. [DOI: 10.1016/j.jaad.2017.09.064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 09/21/2017] [Accepted: 09/29/2017] [Indexed: 01/06/2023]
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Gamret AC, Potluri VS, Krishnamurthy K, Fertig RM. Frontal fibrosing alopecia: efficacy of treatment modalities. Int J Womens Health 2019; 11:273-285. [PMID: 31118828 PMCID: PMC6500869 DOI: 10.2147/ijwh.s177308] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 03/27/2019] [Indexed: 12/19/2022] Open
Abstract
Frontal fibrosing alopecia (FFA) is a primary cicatricial alopecia characterized by loss of follicular stem cells, fibrosis, and a receding frontotemporal hairline, with frequent loss of eyebrows, and less commonly, body hair involvement. Diagnosis is clinical and the disease most often affects postmenopausal women. Treatment is difficult with the goal of disease stabilization rather than hair regrowth due to the scarring nature of FFA. To date, there are no randomized controlled trials evaluating efficacy of treatments. Therefore, much of our knowledge is based on small retrospective studies. In this review, we highlight the various and most current treatment options for FFA, including 5-α-reductase inhibitors, intralesional steroids, hydroxychloroquine, topical steroids, topical calcineurin inhibitors, systemic retinoids, pioglitazone, oral antibiotics, minoxidil, excimer laser, and hair transplantation. Currently, 5-α-reductase inhibitors, intralesional steroids, and hydroxychloroquine have the highest level of evidence for treating FFA, while the remaining therapies have variable results and require further data to draw definitive conclusions.
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Affiliation(s)
- A Caresse Gamret
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - V Sumanth Potluri
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | | | - Raymond M Fertig
- Department of Graduate Medical Education, Orange Park Medical Center, Orange Park, FL, USA
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Medical therapy for frontal fibrosing alopecia: A review and clinical approach. J Am Acad Dermatol 2019; 81:568-580. [PMID: 30953702 DOI: 10.1016/j.jaad.2019.03.079] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 03/24/2019] [Accepted: 03/27/2019] [Indexed: 01/06/2023]
Abstract
BACKGROUND Guidelines for the treatment of frontal fibrosing alopecia (FFA) are limited, and the literature on treatment modalities consists mostly of case reports and cohort studies. OBJECTIVES In this review, we sought to assess the response of medical therapy for FFA and propose a clinical approach to management. METHODS A literature search for "frontal fibrosing alopecia" on PubMed returned 270 items. In this review, only studies with treatment regimens and reported outcomes were considered. The majority of studies found were case reports and retrospective cohort studies. Response to therapy was assessed by reported ability to slow or arrest hair loss. RESULTS Intralesional steroids and 5α-reductase inhibitors were the most commonly used therapies with the most positive treatment responses (88%, 181/204 for intralesional steroids and 88%, 158/180 for 5α-reductase inhibitors). Oral prednisone was seldom used and only temporarily delayed rapid hair loss. Other therapies evaluated included topical steroids, antibiotics, pioglitazone, systemic retinoids, and hair transplantation. LIMITATIONS Lack of placebo control studies and uniform outcome measures. CONCLUSION The natural course of FFA is variable. Recession of the frontal hairline might stabilize regardless of treatment. However, early intervention is encouraged in active disease because hair loss is presumed permanent and treatment could modify the disease course.
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Tavakolpour S, Mahmoudi H, Abedini R, Kamyab Hesari K, Kiani A, Daneshpazhooh M. Frontal fibrosing alopecia: An update on the hypothesis of pathogenesis and treatment. Int J Womens Dermatol 2019; 5:116-123. [PMID: 30997385 PMCID: PMC6451751 DOI: 10.1016/j.ijwd.2018.11.003] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Revised: 10/12/2018] [Accepted: 11/07/2018] [Indexed: 01/10/2023] Open
Abstract
Frontal fibrosing alopecia (FFA) is a relatively new scarring alopecia that is considered a variant of lichen planopilaris (LPP) with no recognized promising treatments. In this study, we tried to clarify the underlying signaling pathways and their roles in the pathogenesis and progression of FFA. Because of several differences in clinical manifestations, response to treatments, and pathological findings, these two conditions could be differentiated from each other. Taking into account the already discussed signaling pathways and involved players such as T cells, mast cells, and sebaceous glands, different possible therapeutic options could be suggested. In addition to treatments supported by clinical evidence, such as 5 alpha-reductase inhibitors, topical calcineurin inhibitors, hydroxychloroquine, peroxisome proliferator-activated receptor gamma agonists, and oral retinoid agents, various other treatment strategies and drugs, such as phototherapy, Janus kinase inhibitors, dehydroepiandrosterone, sirolimus, cetirizine, and rituximab, could be suggested to mitigate disease progression. Of course, such lines of treatment need further evaluation in clinical trials.
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Affiliation(s)
- Soheil Tavakolpour
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - HamidReza Mahmoudi
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Robabeh Abedini
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Kambiz Kamyab Hesari
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Amin Kiani
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Daneshpazhooh
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
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Hu AC, Chapman LW, Mesinkovska NA. The efficacy and use of finasteride in women: a systematic review. Int J Dermatol 2019; 58:759-776. [DOI: 10.1111/ijd.14370] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 10/17/2018] [Accepted: 12/05/2018] [Indexed: 12/19/2022]
Affiliation(s)
- Allison C. Hu
- School of Medicine University of California, Irvine Irvine CA USA
| | - Lance W. Chapman
- Department of Dermatology University of California, San Francisco San Francisco CA USA
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31
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Starace M, Brandi N, Alessandrini A, Bruni F, Piraccini B. Frontal fibrosing alopecia: a case series of 65 patients seen in a single Italian centre. J Eur Acad Dermatol Venereol 2018; 33:433-438. [DOI: 10.1111/jdv.15372] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 10/29/2018] [Indexed: 12/19/2022]
Affiliation(s)
- M. Starace
- Dermatology Department of Specialized, Diagnostic and Experimental Medicine University of Bologna Bologna Italy
| | - N. Brandi
- Dermatology Department of Specialized, Diagnostic and Experimental Medicine University of Bologna Bologna Italy
| | - A. Alessandrini
- Dermatology Department of Specialized, Diagnostic and Experimental Medicine University of Bologna Bologna Italy
| | - F. Bruni
- Dermatology Department of Specialized, Diagnostic and Experimental Medicine University of Bologna Bologna Italy
| | - B.M. Piraccini
- Dermatology Department of Specialized, Diagnostic and Experimental Medicine University of Bologna Bologna Italy
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Mervis J, Borda L, Miteva M. Facial and Extrafacial Lesions in an Ethnically Diverse Series of 91 Patients with Frontal Fibrosing Alopecia Followed at a Single Center. Dermatology 2018; 235:112-119. [DOI: 10.1159/000494603] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 10/08/2018] [Indexed: 11/19/2022] Open
Abstract
Background: Various facial and extrafacial lesions have been reported in frontal fibrosing alopecia (FFA). Facial papules have been associated with worse prognosis. Objectives: We sought to detect the prevalence of facial and extrafacial lesions and to analyze their relation to demographic and clinical variables in a large and ethnically diverse series of patients with FFA. Methods: Charts of patients diagnosed with FFA between January 1, 2015, and December 31, 2017, at the Department of Dermatology, University of Miami, were reviewed retrospectively. Results: 91 patients (87 women and 4 men) met inclusion criteria: 45% (n = 41) were of Hispanic/Latino ethnicity, and 34% (n = 30) were premenopausal. Facial papules were most commonly detected (41% among Hispanic/Latino patients). Significant associations were found between: (1) Hispanic/Latino ethnicity and any FFA-associated facial lesions, facial papules alone, or lichen planus pigmentosus alone, as well as premenopausal status; (2) any FFA-associated facial lesions or facial papules alone and premenopausal status; and (3) Hispanic/Latino ethnicity and simultaneous presence of facial and extrafacial lesions. Conclusions: There is a significant association among Hispanic/Latino ethnicity, facial papules, and premenopausal status, which may portend a susceptibility to severer disease and prompt early and aggressive treatment in this group.
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Porriño-Bustamante ML, López-Nevot MÁ, Aneiros-Fernández J, García-Lora E, Fernández-Pugnaire MA, Arias-Santiago S. Familial frontal fibrosing alopecia: A cross-sectional study of 20 cases from nine families. Australas J Dermatol 2018; 60:e113-e118. [PMID: 30430555 DOI: 10.1111/ajd.12951] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 10/17/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND/OBJECTIVES Frontal fibrosing alopecia (FFA) is a scarring alopecia whose prevalence is increasing. The pathogenesis of this disease is not well known. Genetic, environmental, hormonal and autoimmunity related factors have been considered; however, only a few cases of familial frontal fibrosing alopecia have been reported. MATERIAL AND METHODS A cross-sectional study was performed at University Hospital in Granada (Spain). Twenty patients with frontal fibrosing alopecia belonging to nine different families were included, and clinical and dermoscopic features were analysed. RESULTS Overall, 90% of the patients studied were women (mean age 61.4 years). About 50% of the patients had grade II frontal fibrosing alopecia at the time of diagnosis, whilst 35% had grades III or V. Mean recession was 2.83 cm in the frontal area and 1.99 cm in the temporo-parietal area. Daughters presented a shorter recession area and earlier debut of the disease than mothers. Androgenetic alopecia was found in only two patients (10%). The dermoscopic signs most commonly found were perifollicular erythema (85%), hyperkeratosis (85%), and absence of vellus hair in the hairline (78.9%). CONCLUSION This study adds to the growing evidence that there is a genetic component to frontal fibrosing alopecia. The clinical pattern of frontal fibrosing alopecia was not different from that found in non-familial cases, but the debut of the disease in daughters of mothers with frontal fibrosing alopecia may be earlier.
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Affiliation(s)
| | - Miguel Ángel López-Nevot
- Laboratorio Clínico, Unidad de Histocompatibilidad, Hospital Universitario Virgen de las Nieves, Granada, Spain.,Departamento de Bioquímica, Biología Molecular III e Inmunología, Universidad de Granada, Granada, Spain
| | | | - Elena García-Lora
- Servicio de Dermatología, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | | | - Salvador Arias-Santiago
- Servicio de Dermatología, Hospital Universitario Virgen de las Nieves, Granada, Spain.,Facultad de Medicina, Universidad de Granada, Granada, Spain
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Imhof RL, Chaudhry HM, Larkin SC, Torgerson RR, Tolkachjov SN. Frontal Fibrosing Alopecia in Women: The Mayo Clinic Experience With 148 Patients, 1992-2016. Mayo Clin Proc 2018; 93:1581-1588. [PMID: 30392542 DOI: 10.1016/j.mayocp.2018.05.036] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 05/03/2018] [Accepted: 05/18/2018] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To characterize the clinicopathologic findings, comorbidities, and treatment outcomes of women with frontal fibrosing alopecia. PATIENTS AND METHODS Retrospective review of women with frontal fibrosing alopecia at Mayo Clinic from January 1, 1992, to February 22, 2016. The terms "scarring alopecia," "lichen," "planopilaris," "fibrosing," and "alopecia" were used for the search of female patients aged 1 to 100 years. A total of 686 patients were reviewed to confirm the diagnosis of frontal fibrosing alopecia. Patients were included if they met diagnostic criteria. RESULTS A total of 148 women with frontal fibrosing alopecia were identified, with a mean age of 62 years; 60.1% presented with eyebrow loss; 67.6% and 27.7% described preceding or concurrent pruritus and trichodynia, respectively; 44.6% had a history of hypothyroidism; 13% had a history of surgical menopause; and 63.3% had a history of hormone replacement therapy. A total of 18.2% had lichen planus at other body sites, and 26.3% achieved disease stabilization, often requiring combination therapies. The mean time to remission was 1.8 years. CONCLUSION Patients with frontal fibrosing alopecia typically present with frontotemporal and eyebrow alopecia with preceding symptoms. Hypothyroidism and a history of hysterectomy may be more common than previously reported. Time to presentation, diagnosis, and stabilization is often months to years. Patients who lack treatment response may present with eyebrow loss, eyelash loss, and facial papules. Combination therapy is helpful in achieving slowing of disease progression or disease stabilization, although recurrence is common. Additional studies on treatment and efficacy are needed. Limitations to this study include the retrospective design and varied follow-up.
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Affiliation(s)
- Reese L Imhof
- Mayo Clinic School of Medicine, Mayo Clinic, Rochester, MN
| | - Hafsa M Chaudhry
- Department of Internal Medicine, Brown University, Providence, RI
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Martínez-Velasco MA, Vázquez-Herrera NE, Misciali C, Vincenzi C, Maddy AJ, Asz-Sigall D, Tosti A. Frontal Fibrosing Alopecia Severity Index: A Trichoscopic Visual Scale That Correlates Thickness of Peripilar Casts with Severity of Inflammatory Changes at Pathology. Skin Appendage Disord 2018; 4:277-280. [PMID: 30410896 PMCID: PMC6219238 DOI: 10.1159/000487158] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Accepted: 01/24/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Frontal fibrosing alopecia (FFA) is a scarring alopecia that mainly affects postmenopausal women characterized by recession of the frontotemporal hairline and eyebrow loss. Current techniques to assess FFA activity are limited and involve noninvasive tools that assess disease progression or an invasive technique such as scalp biopsies. However, since progression of FFA is very slow, it is very important to develop a noninvasive technique to assess disease activity to monitor treatment response. OBJECTIVES To provide a standardized and objective method to assess FFA activity. METHODS We evaluated the correlation between trichoscopy and pathological features (degree of lymphocytic infiltration) in 20 dermoscopy-guided biopsies of FFA. At trichoscopy, we divided the severity of peripilar casts into 3 grades according to their thickness. To validate the trichoscopic visual scale, we showed the images to 7 dermatologists with interest in hair diseases. Concordance was assessed using the Kendall Tau-b concordance test. RESULTS A strong correlation between severity of peripilar casts at trichoscopy and degree of lymphocytic infiltrate was observed by the Kendall Tau-b test. Validation showed very good inter- and intraobserver agreement. CONCLUSION The trichoscopic visual scale allows noninvasive assessment of scalp inflammation in FFA in different scalp regions and therefore provides optimal guidance for treatment.
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Affiliation(s)
| | | | - Cosimo Misciali
- Dermatology Division, Department of Experimental, Diagnostic, and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Colombina Vincenzi
- Dermatology Division, Department of Experimental, Diagnostic, and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Austin John Maddy
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Daniel Asz-Sigall
- Clínica de Oncodermatología, Universidad Nacional Autónoma de México, Ciudad de México, Mexico
| | - Antonella Tosti
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
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Valesky EM, Maier MD, Kippenberger S, Kaufmann R, Meissner M. Frontal fibrosierende Alopezie - Review aktueller Fallbeispiele und Fallserien in PubMed. J Dtsch Dermatol Ges 2018; 16:992-1001. [PMID: 30117698 DOI: 10.1111/ddg.13601_g] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 12/28/2017] [Indexed: 12/19/2022]
Affiliation(s)
- Eva Maria Valesky
- Klinik für Dermatologie, Venerologie und Allergologie, Johann Wolfgang Goethe-Universität, Frankfurt am Main
| | - Manuela Denise Maier
- Klinik für Dermatologie, Venerologie und Allergologie, Johann Wolfgang Goethe-Universität, Frankfurt am Main
| | - Stefan Kippenberger
- Klinik für Dermatologie, Venerologie und Allergologie, Johann Wolfgang Goethe-Universität, Frankfurt am Main
| | - Roland Kaufmann
- Klinik für Dermatologie, Venerologie und Allergologie, Johann Wolfgang Goethe-Universität, Frankfurt am Main
| | - Markus Meissner
- Klinik für Dermatologie, Venerologie und Allergologie, Johann Wolfgang Goethe-Universität, Frankfurt am Main
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37
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Valesky EM, Maier MD, Kippenberger S, Kaufmann R, Meissner M. Frontal fibrosing alopecia – review of recent case reports and case series in PubMed. J Dtsch Dermatol Ges 2018; 16:992-999. [DOI: 10.1111/ddg.13601] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 12/28/2017] [Indexed: 12/19/2022]
Affiliation(s)
- Eva Maria Valesky
- Department of DermatologyVenereology and AllergologyUniversity Medical CenterJohann Wolfgang Goethe University Frankfurt am Main Germany
| | - Manuela Denise Maier
- Department of DermatologyVenereology and AllergologyUniversity Medical CenterJohann Wolfgang Goethe University Frankfurt am Main Germany
| | - Stefan Kippenberger
- Department of DermatologyVenereology and AllergologyUniversity Medical CenterJohann Wolfgang Goethe University Frankfurt am Main Germany
| | - Roland Kaufmann
- Department of DermatologyVenereology and AllergologyUniversity Medical CenterJohann Wolfgang Goethe University Frankfurt am Main Germany
| | - Markus Meissner
- Department of DermatologyVenereology and AllergologyUniversity Medical CenterJohann Wolfgang Goethe University Frankfurt am Main Germany
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Vázquez-Herrera NE, Sharma D, Aleid NM, Tosti A. Scalp Itch: A Systematic Review. Skin Appendage Disord 2018; 4:187-199. [PMID: 30197900 PMCID: PMC6120392 DOI: 10.1159/000484354] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 10/18/2017] [Indexed: 12/19/2022] Open
Abstract
Scalp itch is a frequent complaint in the dermatological setting. It is common for the dermatologist to encounter patients with no evident cause of scalp pruritus, making it a distressing situation for both the clinician and the patient. The aim of this paper is to propose a systematic approach to scalp itch, which classifies scalp pruritus into two types: (1) with or (2) without dermatological lesions, and presence or absence of hair loss. Also, it is important to think first about the most common causes and then rule out other, less common etiologies. The acronym SCALLP and the five steps for scalp evaluation (listen, look, touch, magnify, and sample) are useful tools to keep in mind for an assertive approach in these patients.
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Affiliation(s)
| | - Divya Sharma
- Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Nouf Mohammed Aleid
- Department of Dermatology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Antonella Tosti
- Fredric Brandt Endowed Professor of Dermatology, University of Miami, Miami, FL, USA
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Murad A, Bergfeld W. 5-alpha-reductase inhibitor treatment for frontal fibrosing alopecia: an evidence-based treatment update. J Eur Acad Dermatol Venereol 2018. [DOI: 10.1111/jdv.14930] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- A. Murad
- Department of Dermatology; Mater Misericordiae University Hospital; Dublin Ireland
- Department of Dermatology; The Cleveland Clinic Foundation; Cleveland OH USA
| | - W. Bergfeld
- Department of Dermatology; The Cleveland Clinic Foundation; Cleveland OH USA
- Department of Dermatopathology; The Cleveland Clinic Foundation; Cleveland OH USA
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Sundberg JP, Hordinsky MK, Bergfeld W, Lenzy YM, McMichael AJ, Christiano AM, McGregor T, Stenn KS, Sivamani RK, Pratt CH, King LE. Cicatricial Alopecia Research Foundation meeting, May 2016: Progress towards the diagnosis, treatment and cure of primary cicatricial alopecias. Exp Dermatol 2018; 27:302-310. [DOI: 10.1111/exd.13495] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2018] [Indexed: 12/11/2022]
Affiliation(s)
- John P. Sundberg
- The Jackson Laboratory; Bar Harbor ME USA
- Department of Dermatology; Vanderbilt University Medical Center; Nashville TN USA
| | | | - Wilma Bergfeld
- Department of Dermatology and Pathology; Cleveland Clinic; Cleveland OH USA
| | | | | | - Angela M. Christiano
- Department of Dermatology; Columbia University College of Physicians & Surgeons; New York NY USA
| | - Tracy McGregor
- Clinical Genetics; Vanderbilt University Medical Center; Nashville TN USA
| | | | - Raja K. Sivamani
- Department of Dermatology; University of California, Davis; Sacramento CA USA
| | | | - Lloyd E. King
- Department of Dermatology; Vanderbilt University Medical Center; Nashville TN USA
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41
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[Frontal fibrosing alopecia: A case report]. Semergen 2018; 44:e101-e104. [PMID: 29433951 DOI: 10.1016/j.semerg.2017.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 11/23/2017] [Accepted: 12/08/2017] [Indexed: 11/20/2022]
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Rezende HD, Reis Gavazzoni Dias MF, Trüeb RM. Graft versus Host Disease Presenting as Fibrosing Alopecia in a Pattern Distribution: A Model for Pathophysiological Understanding of Cicatricial Pattern Hair Loss. Int J Trichology 2018; 10:80-83. [PMID: 29769782 PMCID: PMC5939008 DOI: 10.4103/ijt.ijt_83_17] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
A case of cutaneous graft versus host disease (GvHD) presenting as fibrosing alopecia in a pattern distribution (FAPD) is discussed, possibly providing a mechanistic model for a better understanding of the pathogenic events underlying cicatricial pattern hair loss. The implication of a follicular inflammation and fibrosis associated with patterned hair loss has emerged from several independent studies. Eventually, Zinkernagel and Trüeb reported a peculiar type of cicatricial pattern hair loss with histopathological features consistent with lichen planopilaris (LPP) associated with androgenetic alopecia (AGA). With regard to its pathogenesis, LPP is regarded to constitute a T-cell-mediated autoimmune reaction. An as yet unknown antigenic stimulus from the malfunctioning hair follicle may initiate a lichenoid tissue reaction that triggers apoptosis of the follicular epithelial cells in the susceptible individual. GvHD is a complication following allogeneic tissue transplantation and is induced and maintained by immunocompetent cells from the donor tissue that particularly attack epithelia of fast-proliferating tissues in the recipient. Due to its analogies with lichen planus, GvHD constitutes a valid immunologic model for lichen planus, LPP and ultimately FAPD. Specifically, the presentation of GvHD of the scalp combines features of AGA and of LPP, as originally proposed in earlier observations on permanent alopecia after bone marrow transplantation.
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Affiliation(s)
| | - Maria Fernanda Reis Gavazzoni Dias
- Department of Dermatology, Center for Medical Sciences, Fluminense Federal University, University Hospital Antonio Pedro, Niterói, Rio de Janeiro, Brazil
| | - Ralph Michel Trüeb
- Center for Dermatology and Hair Diseases Professor Trüeb, Zurich-Wallisellen, Switzerland
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Gkini MA, Riaz R, Jolliffe V. A Retrospective Analysis of Efficacy and Safety of Intralesional Triamcinolone Injections in the Treatment of Frontal Fibrosing Alopecia Either as Monotherapy or as a Concomitant Therapy. Int J Trichology 2018; 10:162-168. [PMID: 30386075 PMCID: PMC6192239 DOI: 10.4103/ijt.ijt_46_18] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Context: Frontal fibrosing alopecia (FFA) is a primary cicatricial alopecia characterized by progressive recession of frontal, and often temporoparietal, hairline mainly in postmenopausal women. Currently, there are no guidelines or proposed evidence-based treatment for FFA. Aims: The aim of this study was to retrospectively evaluate the effect and safety of intralesional triamcinolone acetonide injections (ITAIs) either as monotherapy or as concomitant treatment in the management of hairline recession in FFA. Subjects and Methods: All patients with FFA, who visited our specialist hair clinic from July 2012 to October 2016 and were treated with ITAI either as monotherapy or as concomitant treatment, were enrolled in our study. Measurements were performed from five different points on the scalp. The analysis of data included demographics, associated symptoms, clinical and dermoscopic findings, comorbidities, family history of FFA, concomitant medication, treatment outcome, and recording of adverse events. Statistical Analysis: Statistical analysis was performed using the Statistical Package for the Social Sciences, version 22.0. Results: A total of 40 patients, all females were enrolled in our study. The mean age of the patients was 65.88 ± 8.18 whereas the mean age of the diagnosis was 61.24 ± 7.4. A total of 39 patients were treated with a combination of treatments, including ITAI, and only one with ITAI as monotherapy. There was a halting of the progress of the disease, and no significant adverse events were noted, apart from mild pain. Conclusions: A halting in the progression of FFA was achieved, with unremarkable adverse events. ITAI could serve as an effective and safe option for the treatment of FFA, although difficult to assess it as monotherapy. Further randomized controlled trials are needed to evaluate its efficacy and safety as the sole treatment in the management of FFA.
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Affiliation(s)
- Maria-Angeliki Gkini
- Department of Dermatology, The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Rashid Riaz
- Department of Dermatology, The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Victoria Jolliffe
- Department of Dermatology, The Royal London Hospital, Barts Health NHS Trust, London, UK
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Scribel M, Dutra H, Trüeb RM. Autologous Hair Transplantation in Frontal Fibrosing Alopecia. Int J Trichology 2018; 10:169-171. [PMID: 30386076 PMCID: PMC6192237 DOI: 10.4103/ijt.ijt_37_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
We report a patient with frontal fibrosing alopecia (FFA), in whom autologous hair transplantation was successfully performed despite evidence of active disease. Since the underlying pathology of FFA is usually lichen planopilaris, reservations, and caveats have been expressed with respect to the risk of köbnerization phenomena following hair transplantation surgery. An important question that arises is how the lichenoid tissue reaction pattern is generated around the hair follicles in FFA. Follicles with some form of damage or malfunction might express cytokine profiles that attract inflammatory cells to assist in damage repair or in the initiation of apoptosis-mediated organ deletion. Alternatively, an as yet unknown antigenic stimulus from the damaged or malfunctioning hair follicle might initiate a lichenoid tissue reaction in the immunogenetically susceptible individual. Therefore, it might be expected that the transplantation of whole healthy hair follicles might less give rise to an inflammatory reaction than the disease itself, as revealed in our case report of successful hair transplantation in FFA.
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Affiliation(s)
- Mariana Scribel
- Department of Dermatology, Santa Casa Hospital, Porto Alegre, Brazil
| | - Hudson Dutra
- Center for Dermatology and Hair Diseases Professor Trueb, Zurich-Wallisellen, Switzerland
| | - Ralph M Trüeb
- Center for Dermatology and Hair Diseases Professor Trueb, Zurich-Wallisellen, Switzerland
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Abstract
Since its original report in 1994, frontal fibrosing alopecia has become increasingly common, attracting the attention of the medical community and giving rise to speculations on its etiology, specifically the possibility of environmental factors. Familial cases of frontal fibrosing alopecia point to the possible contribution of hereditary factors maybe related to androgenetic alopecia. We report thefirst case of connubial frontal fibrosing alopecia in a genetically unrelated couple pointing to the possibility of a common environmental exposure in the etiology of the condition. Our observation may be fortuitous, considering the high frequency of female frontal fibrosing alopecia. Nevertheless, the incidence of male frontal fibrosing alopecia has remained low with a consequently low statistical probability of random occurrence of the condition in a marital couple. We, therefore, suggest to systematically includes the hair condition of marital partners in the patient history of patients with frontal fibrosing alopecia, to elucidate the actual frequency of connubial frontal fibrosing alopecia and maybe a common causative agent or hair grooming practice.
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Affiliation(s)
- Ricardo da Silva Libório
- Department of Dermatology and Radiotherapy, Botucatu Medical School, Paulista State University, UNESP, São Paulo, Brazil
| | - Ralph M Trüeb
- Center for Dermatology and Hair Diseases Professor Trüeb, Zurich, Switzerland
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46
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Buendía-Castaño D, Saceda-Corralo D, Moreno-Arrones OM, Fonda-Pascual P, Alegre-Sánchez A, Pindado-Ortega C, Fernandez-Gonzalez P, Vañó-Galván S. Hormonal and Gynecological Risk Factors in Frontal Fibrosing Alopecia: A Case-Control Study. Skin Appendage Disord 2017; 4:274-276. [PMID: 30410895 DOI: 10.1159/000484210] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 10/12/2017] [Indexed: 12/19/2022] Open
Abstract
Introduction Frontal fibrosing alopecia (FFA) is a condition that likely involves an interplay of autoimmune, hormonal, and environmental factors in its pathogenesis. There is a lack of comparative studies demonstrating the presence of hormonal background differences in FFA patients compared to the general population. Materials and Methods A single-center case-control study was designed, including 104 female FFA patients and 208 controls. Patients and controls were interviewed, and extensive data regarding their gynecological and hormonal background were recorded. Results One hundred four cases and 208 age-matched controls were included in the study. A significant difference of 2 years in the age of menopause was detected with a consistent mean increase in fertile life for the control group of 1.7 years. After the multivariate analysis, we found previous intake of tamoxifen to be a risk factor for the development of FFA (OR 14.89). The only protective factor identified was the previous use of an intrauterine device (IUD) (OR 0.22). Conclusions An earlier menopause and tamoxifen intake might promote or maintain FFA, while the use of an IUD might protect from developing FFA. Our results support the previously proposed hypothesis of an underlying hormonal mechanism in the etiopathogenesis of FFA and point out low-estrogen environments as an ideal condition for FFA development.
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Affiliation(s)
| | - David Saceda-Corralo
- Dermatology Service, Trichology Unit, Ramon y Cajal Hospital, Spain.,Trichology Unit, Grupo Pedro Jaén Clinic, Madrid, Spain
| | | | | | | | | | | | - Sergio Vañó-Galván
- Dermatology Service, Trichology Unit, Ramon y Cajal Hospital, Spain.,Trichology Unit, Grupo Pedro Jaén Clinic, Madrid, Spain
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To D, Beecker J. Frontal Fibrosing Alopecia: Update and Review of Challenges and Successes. J Cutan Med Surg 2017; 22:182-189. [DOI: 10.1177/1203475417736279] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Background: Frontal fibrosing alopecia (FFA) is a variant of lichen planopilaris (LPP) and is characterised as a progressive cicatricial alopecia affecting the frontotemporal hairline. Objectives: To perform a comprehensive, up-to-date review of the etiopathogenesis, clinicopathological features, and therapeutic options for FFA. Methods: A literature search was conducted using PubMed (from 1946) and Cochrane (from 1991) databases on March 7, 2017. We included all retrospective and prospective studies reported in English. Only cases studies with reported treatment regimen and outcome were included. No randomised control trials were found. MeSH terms used included frontal fibrosing alopecia, postmenopausal, histopathologic, cicatricial, and treatment. Results: With an increasing incidence of FFA occurring predominantly in postmenopausal women, progress has been made clinically and histologically in understanding this scarring alopecia. Conflicting results have been reported with various treatments, including intralesional or oral corticosteroids, antiandrogens, antimalarials, antibiotics, and surgery. To date, no randomised control trials for treatment of FFA have been conducted. Conclusion: The aetiology and clinical course of FFA remain to be established. Unfortunately, despite the numerous treatment options available, no one therapeutic regimen has proven effective in stopping recession of the hairline and inducing hair growth.
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Affiliation(s)
- Derek To
- Division of Dermatology, Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Jennifer Beecker
- Division of Dermatology, Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada
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Trüeb RM, El Shabrawi-Caelen L, Kempf W. Cutaneous Lupus Erythematosus Presenting as Frontal Fibrosing Alopecia: Report of 2 Patients. Skin Appendage Disord 2017; 3:205-210. [PMID: 29177150 PMCID: PMC5697520 DOI: 10.1159/000475844] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 04/18/2017] [Indexed: 12/19/2022] Open
Abstract
Frontal fibrosing alopecia represents a peculiar condition with a quasi-symmetrical, marginal scarring alopecia along the frontal and temporal hairline. The condition has been associated with further histopathologic and/or clinical evidence of lichen planopilaris. Since its emergence with the original report of Kossard in 1994, frontal fibrosing alopecia has been recognized to be associated with a number of comorbidities, including lupus erythematosus. So far, respective case reports and case series have given account of frontal fibrosing alopecia with the histopathologic features of lichen planopilaris associated or overlapping with lupus erythematosus. In contrast, we present cases of histopathologically proven cutaneous lupus erythematosus presenting as frontal fibrosing alopecia with a good response to the respective treatment with oral hydroxychloroquine and/or intralesional triamcinolone acetonide.
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Affiliation(s)
- Ralph M. Trüeb
- Center for Dermatology and Hair Diseases Professor Trüeb, Zurich-Wallisellen, Switzerland
| | | | - Werner Kempf
- Kempf und Pfaltz Histologische Diagnostik, Zurich, Switzerland
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Tolkachjov SN, Chaudhry HM, Camilleri MJ, Torgerson RR. Frontal fibrosing alopecia among men: A clinicopathologic study of 7 cases. J Am Acad Dermatol 2017; 77:683-690.e2. [DOI: 10.1016/j.jaad.2017.05.045] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 05/30/2017] [Accepted: 05/30/2017] [Indexed: 10/19/2022]
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50
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Saceda-Corralo D, Fernández-Crehuet P, Fonda-Pascual P, Pindado-Ortega C, Moreno-Arrones OM, Vañó-Galván S. Clinical Description of Frontal Fibrosing Alopecia with Concomitant Lichen Planopilaris. Skin Appendage Disord 2017; 4:105-107. [PMID: 29765970 DOI: 10.1159/000479799] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Accepted: 07/21/2017] [Indexed: 12/19/2022] Open
Affiliation(s)
| | | | | | | | | | - Sergio Vañó-Galván
- Dermatology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain.,University of Alcalá, Alcalá de Henares, Madrid, Spain
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