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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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2
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Tekin B, Xie F, Lehman JS. Lichen Planus: What is New in Diagnosis and Treatment? Am J Clin Dermatol 2024:10.1007/s40257-024-00878-9. [PMID: 38982032 DOI: 10.1007/s40257-024-00878-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2024] [Indexed: 07/11/2024]
Abstract
Lichen planus (LP), an idiopathic, multifaceted chronic inflammatory disease with a heterogeneous clinical presentation, affects approximately 0.5-1% of the population. The various clinical manifestations of LP fall into three broad categories, namely cutaneous, appendageal, and mucosal, with further subclassification depending on the morphology and distribution patterns of individual lesions. There is mounting evidence that LP has systemic associations, including autoimmune conditions, glucose intolerance, dyslipidemia, and cardiovascular disorders. Cutaneous hypertrophic and mucosal forms of LP are at a heightened risk for malignant transformation. Familiarity with these potential associations in conjunction with long-term follow-up and regular screening could lead to a timely diagnosis and management of concomitant conditions. In addition, the frequent quality of life (QoL) impairment in LP underscores the need for a comprehensive approach including psychological evaluation and support. Several treatment strategies have been attempted, though most of them have not been adopted in clinical practice because of suboptimal benefit-to-risk ratios or lack of evidence. More recent studies toward pathogenesis-driven treatments have identified Janus kinase inhibitors such as tofacitinib, phosphodiesterase-4 inhibitors such as apremilast, and biologics targeting the interleukin-23/interleukin-17 pathway as novel therapeutic options, resulting in a dramatic change of the treatment landscape of LP. This contemporary review focuses on the diagnosis and management of LP, and places emphasis on more recently described targeted treatment options.
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Affiliation(s)
- Burak Tekin
- Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
- Department of Dermatology, Mayo Clinic, Rochester, MN, USA
| | - Fangyi Xie
- Department of Dermatology, Mayo Clinic, Rochester, MN, USA
- Department of Dermatology, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Julia S Lehman
- Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA.
- Department of Dermatology, Mayo Clinic, Rochester, MN, USA.
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3
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Qiao R, Zhu J, Liu Y, Zhao X, Nie J, Lan X, Li Y, Jiang Y. Refractory alopecia areata with single hairs imitating frontal fibrosing alopecia: a prospective observational study. Int J Dermatol 2024; 63:618-623. [PMID: 38159030 DOI: 10.1111/ijd.17011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 11/30/2023] [Accepted: 12/19/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Lonely hair sign is considered as a clue to the diagnosis of frontal fibrosing alopecia (FFA). OBJECTIVE To report an undescribed variant of alopecia areata (AA) with which the patient developed single hairs and other features similar to FFA and to determine the underlying mechanism. METHODS We conducted a prospective observational study in patients who presented with receding hairline and single hairs, evaluating the clinical, trichoscopic, and histological features and their correlation. Immunochemistry studies were performed to describe the microenvironment. RESULTS Eighteen patients were enrolled in the study. Despite the similarity to FFA clinically, these patients showed different histopathology which revealed a normal number of pilosebaceous units, one anagen hair in one or more pilosebaceous units, and others in telogen stage, consistent with single hairs under the naked eye or under trichoscopy. The severity of the hair loss assessed by SALT was no more than 50, but the response to conventional therapy was poor. CONCLUSIONS This study reports a unique variant of AA. The pathological basis is an increase in the telogen hair follicles, with one anagen hair in one or more pilosebaceous units. Minimal inflammation consisting of CD3+ T lymphocytes and mast cells was demonstrated in the microenvironment.
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Affiliation(s)
- Rui Qiao
- Department of Dermatopathology, Hospital for Skin Diseases and Institute of Dermatology, Chinese Academy of Medical Sciences & Peking Union Medical College, Nanjing, Jiangsu, China
| | - Jiaping Zhu
- Department of Dermatopathology, Hospital for Skin Diseases and Institute of Dermatology, Chinese Academy of Medical Sciences & Peking Union Medical College, Nanjing, Jiangsu, China
| | - Yi Liu
- Department of Plastic and Reconstructive Surgery, Hospital for Skin Diseases and Institute of Dermatology, Chinese Academy of Medical Sciences & Peking Union Medical College, Nanjing, Jiangsu, China
| | - Xiaohui Zhao
- Department of Plastic and Reconstructive Surgery, Hospital for Skin Diseases and Institute of Dermatology, Chinese Academy of Medical Sciences & Peking Union Medical College, Nanjing, Jiangsu, China
| | - Jin Nie
- Clinical Trials and Cosmetics Testing Center, Hospital for Skin Diseases and Institute of Dermatology, Chinese Academy of Medical Sciences & Peking Union Medical College, Nanjing, Jiangsu, China
| | - Xuemei Lan
- Department of Dermatopathology, Hospital for Skin Diseases and Institute of Dermatology, Chinese Academy of Medical Sciences & Peking Union Medical College, Nanjing, Jiangsu, China
| | - Yufen Li
- Department of Dermatopathology, Hospital for Skin Diseases and Institute of Dermatology, Chinese Academy of Medical Sciences & Peking Union Medical College, Nanjing, Jiangsu, China
| | - Yiqun Jiang
- Department of Dermatopathology, Hospital for Skin Diseases and Institute of Dermatology, Chinese Academy of Medical Sciences & Peking Union Medical College, Nanjing, Jiangsu, China
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4
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Roman AM, Petca RC, Dumitrașcu MC, Petca A, Ionescu (Miron) AI, Șandru F. Frontal Fibrosing Alopecia and Reproductive Health: Assessing the Role of Sex Hormones in Disease Development. J Pers Med 2024; 14:72. [PMID: 38248773 PMCID: PMC10817300 DOI: 10.3390/jpm14010072] [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: 11/30/2023] [Revised: 12/29/2023] [Accepted: 01/03/2024] [Indexed: 01/23/2024] Open
Abstract
Frontal Fibrosing Alopecia (FFA) is a distinctive form of cicatricial alopecia characterized by gradual hairline recession, predominantly affecting postmenopausal individuals, thus implying a potential hormonal origin. This narrative review, spanning 2000 to 2023, delves into PubMed literature, focusing on the menopausal and hormonal status of women with FFA. The objective is to unravel the intricate nature of FFA and its plausible associations with hormonal dysregulations in women. While menopause remains a pivotal demographic characteristic linked to FFA, existing data suggest that its hormonal imbalances may not fully account for the development of FFA. Conversely, substantial evidence indicates a strong association between a reduction in fertile years, particularly through surgical interventions leading to an abrupt hormonal imbalance, and FFA in women. Additionally, exposure to hormone replacement therapy or oral contraceptives has shown varying degrees of association with FFA. Gynecologists should maintain a heightened awareness regarding the ramifications of their interventions and their pivotal role in overseeing women's fertility, recognizing the potential influence on the progression of FFA. The recurrent theme of hormonal disruption strongly implies a causal connection between alterations in sex hormones and FFA in women. Nevertheless, this relationship's extent and underlying mechanisms remain subjects of ongoing debate.
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Affiliation(s)
- Alexandra-Maria Roman
- Dermatology Department, “Elias” University Emergency Hospital, 011461 Bucharest, Romania; (A.-M.R.); (F.Ș.)
| | - Răzvan-Cosmin Petca
- Department of Urology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Department of Urology, “Prof. Dr. Th. Burghele” Clinical Hospital, 050659 Bucharest, Romania
| | - Mihai Cristian Dumitrașcu
- Department of Obstetrics and Gynecology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Department of Obstetrics and Gynecology, University Emergency Hospital of Bucharest, 050098 Bucharest, Romania
| | - Aida Petca
- Department of Obstetrics and Gynecology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Department of Obstetrics and Gynecology, “Elias” Emergency University Hospital, 011461 Bucharest, Romania
| | - Andreea-Iuliana Ionescu (Miron)
- Department of Oncological Radiotherapy and Medical Imaging, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Department of Medical Oncology, Colțea Clinical Hospital, 030167 Bucharest, Romania
| | - Florica Șandru
- Dermatology Department, “Elias” University Emergency Hospital, 011461 Bucharest, Romania; (A.-M.R.); (F.Ș.)
- Department of Dermatovenerology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
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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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Popa A, Carsote M, Cretoiu D, Dumitrascu MC, Nistor CE, Sandru F. Study of the Thyroid Profile of Patients with Alopecia. J Clin Med 2023; 12:jcm12031115. [PMID: 36769763 PMCID: PMC9918246 DOI: 10.3390/jcm12031115] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 01/26/2023] [Accepted: 01/30/2023] [Indexed: 02/04/2023] Open
Abstract
Thyroid hormones are required for the physiological growth and maintenance of hair follicles. We aim to study the thyroid profile of patients with alopecia. This is a narrative review. PubMed literature was searched from 2013 to 2022. We followed different types of alopecia: alopecia areata (AA), androgenic alopecia in males and females, telogen effluvium (TE), frontal fibrosing alopecia (FFA), lichen planopilaris, and alopecia neoplastica (AN). AA shares a common autoimmune background with autoimmune thyroid diseases, either sporadic or belonging to autoimmune polyglandular syndromes. Some data suggested that AA is more severe if thyroid anomalies are confirmed, including subclinical dysfunction or positive antithyroid antibodies with normal hormone values. However, routine thyroid screening for patients with AA, if the patients are asymptomatic from a thyroid point of view and they have negative personal and family history of autoimmunity, remains controversial. TE, apart from the autoimmune type, associates thyroid anomalies of a hormonal assay (between 5.7% and 17%). FFA, mostly a postmenopausal entity (however, not exclusive), associates a higher prevalence of thyroid conditions (up to 50%) than the general population. However, these might have an age-dependent pattern, thus the association may be incidental since there are a limited number of studies. Overall, alopecia remains a very challenging condition for patients and physicians; a multidisciplinary team is required to improve the outcome and quality of life. The common autoimmune background is suggestive of some types of alopecia and thyroid disorders, yet, the underlying mechanisms are still a matter of debate. AA, TE, FFA, LPP, and, potentially, female pattern hair loss have been found to be connected with thyroid entities, thus a state of awareness from a dual perspective, of trichology and endocrinology, is helpful.
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Affiliation(s)
- Adelina Popa
- Department of Dermatovenerology, “Carol Davila University” of Medicine and Pharmacy & “Elias” University Emergency Hospital, 011461 Bucharest, Romania
| | - Mara Carsote
- Department of Endocrinology, “Carol Davila” University of Medicine and Pharmacy & “C.I. Parhon” National Institute of Endocrinology, 011461 Bucharest, Romania
- Correspondence:
| | - Dragos Cretoiu
- Department of Cellular and Molecular Biology, and Histology, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy & National Institute for Mother and Child Health Alessandrescu-Rusescu, 011461 Bucharest, Romania
| | - Mihai Cristian Dumitrascu
- Department of Obstetrics and Gynaecology, “Carol Davila” University of Medicine and Pharmacy & University Emergency Hospital, 011461 Bucharest, Romania
| | - Claudiu-Eduard Nistor
- Department 4–Cardio-Thoracic Pathology, Thoracic Surgery II Discipline, “Carol Davila” University of Medicine and Pharmacy & Thoracic Surgery Department, “Carol Davila” Central Emergency University Military Hospital, 011461 Bucharest, Romania
| | - Florica Sandru
- Department of Dermatovenerology, “Carol Davila University” of Medicine and Pharmacy & “Elias” University Emergency Hospital, 011461 Bucharest, Romania
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7
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Diehl KL, Erickson CP, Calame A, Cohen PR. Frontal Fibrosing Alopecia Mimicking Alopecia Syphilitica. Cureus 2022; 14:e21901. [PMID: 35265425 PMCID: PMC8898542 DOI: 10.7759/cureus.21901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2022] [Indexed: 12/02/2022] Open
Abstract
Frontal fibrosing alopecia is lymphocytic scarring alopecia most commonly affecting postmenopausal women. Alopecia syphilitica, an uncommon manifestation of secondary syphilis, is characterized as a nonscarring and non-inflammatory hair loss that primarily affects the scalp. Frontal fibrosing alopecia has a classic pattern of hair loss involving regression of frontotemporal hair; it also may affect the eyebrows or other sites of the body. The typical patterns of frontal fibrosing alopecia are characterized as diffuse and linear. In addition, patients with frontal fibrosing alopecia can have atypical signs and patterns of hair loss. The atypical signs and patterns of frontal fibrosing alopecia are the androgenetic-like pattern, clown alopecia pattern, cockade-like pattern, doll hairline sign, lonely hair sign, ophiasis-like pattern, pseudo-fringe sign, and upsilon pattern. We observed a woman with a traditional pattern of frontal fibrosing alopecia whose hair loss involved the frontotemporal scalp areas; however, she also had hair loss in the occipital scalp that appeared similar to the moth-eaten alopecia of alopecia syphilitica. Her rapid plasma reagin was negative and the biopsies from her frontal scalp and occipital scalp both showed scarring alopecia consistent with frontal fibrosing alopecia. Her alopecia persisted with conservative treatment, and she returned to wearing a wig. Alopecia syphilitica-like pattern of hair loss can be added to the other atypical patterns of alopecia that may potentially be observed in a patient with frontal fibrosing alopecia.
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8
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Imhof RL, Cantwell HM, Proffer SL, Tolkachjov SN, Torgerson RR, Tollefson MM. The spectrum of pediatric scarring alopecia: A retrospective review of 27 patients seen at Mayo Clinic. Pediatr Dermatol 2021; 38:580-584. [PMID: 33644931 DOI: 10.1111/pde.14543] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND/OBJECTIVE There are few studies examining pediatric scarring alopecia. The objective of this study is to characterize the clinicopathologic findings, comorbidities, and treatment outcomes of pediatric patients with scarring alopecia. METHODS Retrospective review of patients under age 18 diagnosed with scarring alopecia at Mayo Clinic from 01/01/1992 through 02/05/2019. RESULTS 27 patients met inclusion criteria with a mean age of 11.2 years and a racial breakdown of 85.2% (23) White, 11.1% (3) Black, and 3.7% (1) Multiracial. Clinical scarring was noted in most (23, 85.2%). Biopsy confirmed the diagnosis in most (24, 88.9%). The most common diagnoses were folliculitis decalvans (6, 22.2%), lichen planopilaris (6, 22.2%), aplasia cutis congenita (4, 14.8%), tinea capitis (4, 14.8%), and morphea (3, 11.1%). Comorbid depression (6, 22.2%) and anxiety (6, 22.2%) were prevalent. Of the patients who received follow-up, most who pursued treatment achieved stabilization (55.5%) or slowing of progression (27.8%), with 44.4% of those treated experiencing regrowth. Mean time to stabilization in the treated population was 19.6 months. Two patients did not pursue treatment, but received follow-up and these untreated patients did not experience hair regrowth. CONCLUSIONS Most patients presented with clinically evident primary scarring alopecia. Biopsy may confirm the diagnosis. Active treatment should be pursued, and successful treatment often requires combination therapies. Time to stabilization often takes years. Screening for depression and anxiety should be pursued.
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Affiliation(s)
- Reese L Imhof
- Mayo Clinic Alix School of Medicine, Rochester, MN, USA
| | | | - Sydney L Proffer
- Department of Internal Medicine, The Christ Hospital, Cincinnati, OH, USA
| | | | | | - Megha M Tollefson
- Department of Dermatology, Mayo Clinic, Rochester, MN, USA.,Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
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9
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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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10
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Babadjouni A, Pouldar Foulad D, Hedayati B, Evron E, Mesinkovska N. The Effects of Smoking on Hair Health: A Systematic Review. Skin Appendage Disord 2021; 7:251-264. [PMID: 34307472 DOI: 10.1159/000512865] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 11/05/2020] [Indexed: 01/06/2023] Open
Abstract
Smoking is not only a preventable cause of significant systemic disease but also affects the follicular growth cycle and fiber pigmentation. Ambient tobacco smoke exposure results in nicotine accumulation in hair follicles and the hair shaft. This review summarizes the evidence on the association between smoking and hair health, as denoted by alopecia and premature hair graying (PHG). In July 2020, a review of the literature using PubMed/MEDLINE and CINAHL databases identified 32 studies investigating the relationship between smoking, PHG, and alopecia (androgenetic alopecia and frontal fibrosing alopecia). The prevalence of hair loss and PHG is more prevalent in smokers than nonsmokers. Smoking is associated with negative effects on hair health as evidenced in PHG and alopecia. Smoking status should be assessed in patients who are presenting to their dermatologist for evaluation of alopecia and PHG.
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Affiliation(s)
- Arash Babadjouni
- Department of Dermatology, University of California Irvine, Irvine, California, USA.,Midwestern University - Arizona College of Osteopathic Medicine, Glendale, Arizona, USA
| | | | - Bobak Hedayati
- Department of Dermatology, University of California Irvine, Irvine, California, USA
| | - Evyatar Evron
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Natasha Mesinkovska
- Department of Dermatology, University of California Irvine, Irvine, California, USA
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11
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Eid E, Abou-Rahal J, Khoury D, Kurban M, Abbas O. Reply to ''Coexistence of frontal fibrosing alopecia and alopecia areata: 3 new cases and review of the literature'': plasmacytoid dendritic cell as possible link. Int J Dermatol 2021; 60:e234-e235. [PMID: 33590490 DOI: 10.1111/ijd.15469] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Revised: 01/07/2021] [Accepted: 01/21/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Edward Eid
- Department of Dermatology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Jihane Abou-Rahal
- Department of Dermatology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Dana Khoury
- Department of Dermatology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Mazen Kurban
- Department of Dermatology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ossama Abbas
- Department of Dermatology, American University of Beirut Medical Center, Beirut, Lebanon
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12
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Aragón CC, Ruiz-Ordoñez I, Nieto-Aristizábal I, Sánchez A, Muñoz LE, Vásquez S, Montoya C, Tobón GJ. Letter to the editor: Frontal fibrosing alopecia: An autoimmune manifestation? Autoimmun Rev 2020; 20:102728. [PMID: 33321246 DOI: 10.1016/j.autrev.2020.102728] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 11/18/2020] [Indexed: 10/22/2022]
Affiliation(s)
- Cristian C Aragón
- GIRAT: Grupo de Investigación en Reumatología, Autoinmunidad y Medicina Traslacional, Universidad Icesi and Fundación Valle del Lili, Cali, Colombia
| | - Ingrid Ruiz-Ordoñez
- GIRAT: Grupo de Investigación en Reumatología, Autoinmunidad y Medicina Traslacional, Universidad Icesi and Fundación Valle del Lili, Cali, Colombia; Fundación Valle del Lili, Centro de Investigaciones Clínicas, Cra 98 No. 18 - 49, Cali 760032, Colombia
| | - Ivana Nieto-Aristizábal
- GIRAT: Grupo de Investigación en Reumatología, Autoinmunidad y Medicina Traslacional, Universidad Icesi and Fundación Valle del Lili, Cali, Colombia; Fundación Valle del Lili, Centro de Investigaciones Clínicas, Cra 98 No. 18 - 49, Cali 760032, Colombia
| | - Aura Sánchez
- Fundación Valle del Lili, Department of Pathology, Laboratory Unit, Cra 98 No. 18 - 49, Cali 760032, Colombia
| | - Liliana Eugenia Muñoz
- Fundación Valle del Lili, Dermatopathology Unit, Cra 98 No. 18 - 49, Cali 760032, Colombia
| | - Sara Vásquez
- Fundación Valle del Lili, Dermatopathology Unit, Cra 98 No. 18 - 49, Cali 760032, Colombia; Universidad Icesi, Calle 18 No. 122 - 135, Cali, Colombia
| | - Claudia Montoya
- Universidad del norte, Dermatology Unit, Km.5 Vía Puerto Colombia, Barranquilla, Colombia
| | - Gabriel J Tobón
- GIRAT: Grupo de Investigación en Reumatología, Autoinmunidad y Medicina Traslacional, Universidad Icesi and Fundación Valle del Lili, Cali, Colombia; Fundación Valle del Lili, Rheumatology Unit, Cra 98 No. 18 - 49, Cali 760032, Colombia.
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13
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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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Affiliation(s)
| | - Dawn Marie R Davis
- Department of Dermatology and.,Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN
| | - Megha M Tollefson
- Department of Dermatology and.,Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN
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Cantwell HM, Wieland CN, Proffer SL, Imhof RL, Torgerson RR, Tolkachjov SN. Lichen planopilaris in men: a retrospective clinicopathologic study of 19 patients. Int J Dermatol 2020; 60:482-488. [PMID: 33128471 DOI: 10.1111/ijd.15285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 09/28/2020] [Accepted: 10/06/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Lichen planopilaris (LPP) is a scarring alopecia rarely described in men. OBJECTIVE To investigate the clinical and histopathologic features of LPP in men. METHODS We performed a retrospective cohort study of male patients with LPP seen at Mayo Clinic between 1992 and 2016. RESULTS Nineteen men with biopsy-confirmed LPP were included. The disease most commonly presented with diffuse (42.1%) or vertex scalp (42.1%) involvement. None of the patients had eyebrow or body hair involvement. Perifollicular erythema (94.7%) and pruritus (57.9%) were the most frequent clinical findings. Androgenetic alopecia (AGA) co-occurred in 26.3% of patients. Mucosal lichen planus was found in four patients (21.1%). Thyroid disease occurred in three patients (15.8%). Disease improvement (47.3%) occurred with combination topical and systemic therapy, topical clobetasol monotherapy, and minocycline monotherapy. CONCLUSIONS LPP in men has similar clinical and histologic presentations as reported in women. Nonscalp hair loss appears less likely in men with classic LPP than reported in men with frontal fibrosing alopecia, while mucosal lichen planus and thyroid disease appear to be more common in classic LPP. Men with AGA can present with new-onset concomitant LPP. Limitations included small study size, variable follow-up, and lack of standardized clinical assessment due the study's retrospective nature.
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Affiliation(s)
| | - Carilyn N Wieland
- Department of Dermatology, Mayo Clinic, Rochester, MN, USA.,Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Sydney L Proffer
- Department of Internal Medicine, The Christ Hospital, Cincinnati, OH, USA
| | - Reese L Imhof
- Mayo Clinic Alix School of Medicine, Rochester, MN, USA
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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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Bosch-Amate X, Riquelme-McLoughlin C, Morgado-Carrasco D, Rojano-Fritz L, Iranzo-Fernández P. Report of two cases of mucous membrane pemphigoid with frontal fibrosing alopecia: a variant of lichen planus pemphigoides or an incidental finding? Clin Exp Dermatol 2020; 45:727-731. [PMID: 32311113 DOI: 10.1111/ced.14248] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2020] [Indexed: 12/19/2022]
Abstract
Lichen planus pemphigoides (LPP) is a rare autoimmune subepidermal blistering disease characterized by the coexistence of both lichen planus and either bullous pemphigoid or mucous membrane pemphigoid (MMP) features. Frontal fibrosing alopecia (FFA) is a scarring alopecia, generally considered a form of lichen planopilaris. We report two patients with concomitant FFA and MPP. Patient 1 was a 73-year-old woman with the clinical and histological diagnosis of oral lichen planus. In addition, she presented alopecic plaques in the parietal area with blisters, immunohistologically compatible with Brunsting-Perry pemphigoid, a variant of MMP. During follow-up, the patient also developed FFA. Patient 2 was a 70-year-old woman with a history of ocular inflammation and desquamative gingivitis, who was diagnosed with MMP based on a conjunctival biopsy. She also had clinical features of FFA. ELISA and frontal biopsy confirmed the diagnoses of MMP and FFA. In conclusion, we report two patients with MMP associated with FFA, and discuss whether this association is a new variant of LPP or an incidental finding.
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Affiliation(s)
- X Bosch-Amate
- Dermatology Department, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - C Riquelme-McLoughlin
- Dermatology Department, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - D Morgado-Carrasco
- Dermatology Department, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - L Rojano-Fritz
- Dermatology Department, Instituto Dermatológico de Jalisco 'Dr. José Barba Rubio' Zapopan, Jalisco, México
| | - P Iranzo-Fernández
- Dermatology Department, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
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Imhof RL, Larkin SC, Cantwell HM, Torgerson RR, Tolkachjov SN. The association of frontal fibrosing alopecia with skin and hair care products: A survey-based case series of 56 patients seen at the Mayo Clinic. J Am Acad Dermatol 2020; 84:532-534. [PMID: 32437720 DOI: 10.1016/j.jaad.2020.03.129] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Revised: 02/01/2020] [Accepted: 03/19/2020] [Indexed: 11/17/2022]
Affiliation(s)
- Reese L Imhof
- Mayo Clinic Alix School of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Sydney C Larkin
- Mayo Clinic Alix School of Medicine, Mayo Clinic, Rochester, Minnesota
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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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Byth LA. Renaming frontal fibrosing alopecia is a step too far. J Am Acad Dermatol 2019; 81:e79. [DOI: 10.1016/j.jaad.2019.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Accepted: 05/07/2019] [Indexed: 11/25/2022]
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