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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: 5] [Impact Index Per Article: 1.7] [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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2
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Iamsumang W, Rutnin S, Suchonwanit P. Comedone-Like Lesions as a Manifestation of Lichen Planopilaris beyond the Scalp: A Case Report with Dermoscopic Features and Literature Review. Case Rep Dermatol 2021; 13:106-113. [PMID: 33790753 PMCID: PMC7989723 DOI: 10.1159/000512711] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 10/29/2020] [Indexed: 01/03/2023] Open
Abstract
Lichen planopilaris is a rare inflammatory condition that is also known as follicular lichen planus. Although the condition commonly affects the scalp, it sometimes involves the other regions of the body with a variety of clinical presentations. The involvement beyond the scalp is considered to be a generalized nature of disease process. In this report, we present a case of generalized follicular lichen planus in a 34-year-old Thai female presenting with comedone-like lesions on the trunk and extremities as well as scarring alopecia on the scalp. Dermoscopic features were also discussed.
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Affiliation(s)
- Wimolsiri Iamsumang
- Division of Dermatology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Suthinee Rutnin
- Division of Dermatology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Poonkiat Suchonwanit
- Division of Dermatology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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3
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Fatemi F, Mohaghegh F, Danesh F, saber M, Rajabi P. Isotretinoin for the treatment of facial lichen planopilaris: A new indication for an old drug, a case series study. Clin Case Rep 2020; 8:2524-2529. [PMID: 33363772 PMCID: PMC7752461 DOI: 10.1002/ccr3.3210] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 07/02/2020] [Accepted: 07/08/2020] [Indexed: 12/19/2022] Open
Abstract
Despite the little information about the facial papules due to Lichen planopilaris (LPP), we have many cases with facial skin roughness in which histological study has showed LPP. Additionally, in those patients treating for frontal fibrosing alopecia or scalp LPP there was no improvement in facial papules.
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Affiliation(s)
- Farahnaz Fatemi
- Department of DermatologySchool of MedicineIsfahan University of Medical SciencesIsfahanIran
| | - Fatemeh Mohaghegh
- Department of DermatologySchool of MedicineIsfahan University of Medical SciencesIsfahanIran
| | - Farzaneh Danesh
- Department of DermatologySchool of MedicineIsfahan University of Medical SciencesIsfahanIran
| | - Mina saber
- Department of DermatologySchool of MedicineIsfahan University of Medical SciencesIsfahanIran
| | - Parvin Rajabi
- Pathology DepartmentFaculty of MedicineIsfahan university of Medical SciencesIsfahanIran
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4
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Frontal Fibrosing Alopecia Involving the Limbs Shows Inflammatory Pattern on Histology: A Review of 13 Cases. Am J Dermatopathol 2020; 42:226-229. [PMID: 31408007 DOI: 10.1097/dad.0000000000001500] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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5
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Bagatin E, Costa CS, Rocha MADD, Picosse FR, Kamamoto CSL, Pirmez R, Ianhez M, Miot HA. Consensus on the use of oral isotretinoin in dermatology - Brazilian Society of Dermatology. An Bras Dermatol 2020; 95 Suppl 1:19-38. [PMID: 33036809 PMCID: PMC7772596 DOI: 10.1016/j.abd.2020.09.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 05/11/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Isotretinoin is a synthetic retinoid, derived from vitamin A, with multiple mechanisms of action and highly effective in the treatment of acne, despite common adverse events, manageable and dose-dependent. Dose-independent teratogenicity is the most serious. Therefore, off-label prescriptions require strict criteria. OBJECTIVE To communicate the experience and recommendation of Brazilian dermatologists on oral use of the drug in dermatology. METHODS Eight experts from five universities were appointed by the Brazilian Society of Dermatology to develop a consensus on indications for this drug. Through the adapted DELPHI methodology, relevant elements were listed and an extensive analysis of the literature was carried out. The consensus was defined with the approval of at least 70% of the experts. RESULTS With 100% approval from the authors, there was no doubt about the efficacy of oral isotretinoin in the treatment of acne, including as an adjunct in the correction of scars. Common and manageable common adverse events are mucocutaneous in nature. Others, such as growth retardation, abnormal healing, depression, and inflammatory bowel disease have been thoroughly investigated, and there is no evidence of a causal association; they are rare, individual, and should not contraindicate the use of the drug. Regarding unapproved indications, it may represent an option in cases of refractory rosacea, severe seborrheic dermatitis, stabilization of field cancerization with advanced photoaging and, although incipient, frontal fibrosing alopecia. For keratinization disorders, acitretin performs better. In the opinion of the authors, indications for purely esthetic purposes or oil control are not recommended, particularly for women of childbearing age. CONCLUSIONS Approved and non-approved indications, efficacy and adverse effects of oral isotretinoin in dermatology were presented and critically evaluated.
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Affiliation(s)
- Ediléia Bagatin
- Department of Dermatology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | | | | | - Fabíola Rosa Picosse
- Department of Dermatology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | | | - Rodrigo Pirmez
- Centro de Estudos dos Cabelos, Instituto de Dermatologia Professor Rubem David Azulay, Santa Casa da Misericórdia do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Mayra Ianhez
- Department of Tropical Medicine and Dermatology, Universidade Federal de Goiás, Goiânia, GO, Brazil
| | - Hélio Amante Miot
- Department of Dermatology, Faculdade de Ciências Médicas e Biológicas de Botucatu, Universidade Estadual Paulista, Botucatu, SP, Brazil.
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6
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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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7
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Ramos PM, Anzai A, Duque-Estrada B, Farias DC, Melo DF, Mulinari-Brenner F, Pinto GM, Abraham LS, Santos LDN, Pirmez R, Miot HA. Risk factors for frontal fibrosing alopecia: A case-control study in a multiracial population. J Am Acad Dermatol 2020; 84:712-718. [PMID: 32835739 DOI: 10.1016/j.jaad.2020.08.076] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 08/11/2020] [Accepted: 08/14/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Frontal fibrosing alopecia (FFA) is a chronic cicatricial alopecia with unknown etiology and a worldwide rising incidence. OBJECTIVE The objective of this study was to evaluate the association of FFA with demographic and exposure factors in a Brazilian multiracial population. METHODS A multicenter case-control study was conducted in 11 referral centers throughout Brazil. The study was a case-control study that prospectively recruited 902 participants (451 patients with FFA and 451 sex-matched control individuals). Study participants completed a thorough questionnaire comprising variables grouped as baseline demographics, environmental exposure, diet, hormonal factors, allergies, and hair and skin care. RESULTS When adjusted by sex, age, menopause, and skin color, FFA was associated with hair straightening with formalin (odds ratio [OR], 3.18), use of ordinary (nondermatologic) facial soap (OR, 2.09) and facial moisturizer (OR, 1.99), thyroid disorders (OR, 1.69), and rosacea (OR, 2.08). Smokers (OR, 0.33) and users of antiresidue/clarifying shampoo (OR, 0.35) presented a negative association with FFA. There was no association with the use of sunscreen. LIMITATIONS Recall bias. CONCLUSIONS The association with moisturizers, ordinary facial soap, and hair straightening with formalin and the negative association with antiresidue/clarifying shampoo reinforce the possibility of an exogenous particle triggering FFA.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Rodrigo Pirmez
- Santa Casa de Misericórdia do Rio de Janeiro, Rio de Janeiro, Brazil
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8
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Pindado-Ortega C, Perna C, Saceda-Corralo D, Fernández-Nieto D, Jaén-Olasolo P, Vañó-Galván S. Frontal fibrosing alopecia: histopathological, immunohistochemical and hormonal study of clinically unaffected scalp areas. J Eur Acad Dermatol Venereol 2019; 34:e84-e85. [PMID: 31566821 DOI: 10.1111/jdv.15977] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- C Pindado-Ortega
- Dermatology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain.,Dermatology Department, Hospital Universitario Infanta Leonor, Madrid, Spain.,Grupo Dermatología Pedro Jaén, Madrid, Spain
| | - C Perna
- Pathology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - D Saceda-Corralo
- Dermatology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain.,Grupo Dermatología Pedro Jaén, Madrid, Spain
| | - D Fernández-Nieto
- Dermatology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - P Jaén-Olasolo
- Dermatology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain.,Grupo Dermatología Pedro Jaén, Madrid, Spain
| | - S Vañó-Galván
- Dermatology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain.,Grupo Dermatología Pedro Jaén, Madrid, Spain
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9
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Iorizzo M, Tosti A. Frontal Fibrosing Alopecia: An Update on Pathogenesis, Diagnosis, and Treatment. Am J Clin Dermatol 2019; 20:379-390. [PMID: 30659454 DOI: 10.1007/s40257-019-00424-y] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Frontal fibrosing alopecia (FFA), first described by Kossard in the early 1990s, is a form of primary lymphocytic cicatricial alopecia characterized by selective involvement of the frontotemporal hairline and eyebrows. Since the original description, an increasing number of cases have been reported worldwide and the clinical aspects of the disease have been better characterized. However, the pathogenesis is still unknown and several hypotheses have been made about possible triggering factors, including hormones, neurogenic inflammation, smoking, UV filters, and ingredients in leave-on facial products. A genetic basis has also been hypothesized as the disease can occur in siblings and members of the same family. Besides its pathogenesis, research is also focused on treatment; FFA is a chronic condition and at present there is no validated or approved treatment for this disorder. Commonly prescribed topical treatments include corticosteroids, minoxidil, and calcineurin inhibitors. Systemic treatments include 5α-reductase inhibitors, hydroxychloroquine, and retinoids. Intralesional triamcinolone acetonide is also utilized, especially for the eyebrows. Other possible treatments include pioglitazone, naltrexone, tofacitinib, and lasers.
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Affiliation(s)
- Matilde Iorizzo
- Private Dermatology Practice, Viale Stazione 16, 6500, Bellinzona, Switzerland.
| | - Antonella Tosti
- Fredric Brandt Endowed Professor of Dermatology, Miller School of Medicine, University of Miami, Miami, FL, USA
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10
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Abstract
Frontal fibrosing alopecia (FFA) is an irreversible scarring alopecia with unknown etiology and no cure. The goal is to establish the diagnosis in the early stage, before developing a hairless band of atrophy involving the frontal, temporal scalp and sideburns. Pathology is rarely needed once the disease is clinically apparent. The classic histologic features include follicular dropout with the absence or atrophy of the sebaceous glands and lichenoid lymphohistiocytic infiltrate with concentric layered fibrosis at the upper follicular level. We describe a common pattern that was repeatedly seen in 6 horizontally sectioned scalp biopsies from patients with early presentation of FFA suspected on trichoscopy by the focal presence of peripilar casts around terminal hairs. All biopsies revealed overall preserved follicular architecture with average number of 11 vellus follicles, atrophy of the sebaceous glands, and perifollicular lymphohistiocytic infiltrate involving the outer root sheath of the vellus follicles (n = 5). There was no perifollicular fibrosis of the vellus follicles and no lichenoid inflammation and perifollicular fibrosis of the terminal follicles. This new pattern of "inflammatory vellus involvement" most likely corresponds to an early onset of the disease. The absence of the classic features in such biopsies from early FFA can lead to misdiagnosis.
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11
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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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12
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Arshdeep, Batrani M, Kubba A, Kubba R. Lichen planopilaris beyond scalp: a case series with dermoscopy-histopathology correlation. Int J Dermatol 2018; 57:e127-e131. [PMID: 30073666 DOI: 10.1111/ijd.14168] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 07/02/2018] [Accepted: 07/04/2018] [Indexed: 01/06/2023]
Affiliation(s)
- Arshdeep
- Delhi Dermatology Group, New Delhi, India
| | | | - Asha Kubba
- Delhi Dermatology Group, New Delhi, India
| | - Raj Kubba
- Delhi Dermatology Group, New Delhi, India
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13
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Mirmirani P, Tosti A, Goldberg L, Whiting D, Sotoodian B. Frontal Fibrosing Alopecia: An Emerging Epidemic. Skin Appendage Disord 2018; 5:90-93. [PMID: 30815440 DOI: 10.1159/000489793] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 04/16/2018] [Indexed: 12/19/2022] Open
Abstract
Since the initial description of frontal fibrosing alopecia (FFA) in 1994, increasingly more cases of FFA have been reported in literature. Although clear epidemiologic data on the incidence and prevalence of FFA is not available, it is intriguing to consider whether FFA should be labeled as an emerging epidemic. A medline trend analysis as well as literature review using keywords "alopecia," "hair loss," and "cicatrical" were performed. Medline trend analysis of published FFA papers from 1905 to 2016 showed that the number of publications referenced in Medline increased from 1 (0.229%) in 1994 to 44 (3.5%) in 2016. The number of patients per published cohort also increased dramatically since the first report of FFA. Over the time period of January 2006-2016, our multi hair-referral centers collaboration study also showed a significant increase in new diagnoses of FFA. At this juncture, the cause for the rapid rise in cases is one of speculation. It is plausible that a cumulative environmental or toxic factor may trigger hair loss in FFA. Once perhaps a "rare type" of cicatricial alopecia, FFA is now being seen in a frequency in excess of what is expected, thus suggestive of an emerging epidemic.
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Affiliation(s)
- Paradi Mirmirani
- Department of Dermatology, The Permanente Medical Group, Vallejo, California, USA.,Department of Dermatology, University of California, San Francisco, California, USA.,Case Western Reserve University, Cleveland, Ohio, USA
| | - Antonella Tosti
- Department of Dermatology and Cutaneous Surgery, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Lynne Goldberg
- Department of Dermatology, Boston University School of Medicine, Boston, Massachusetts, USA
| | - David Whiting
- Department of Dermatology and Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Bahman Sotoodian
- Division of Dermatology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
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14
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Cervantes J, Miteva M. Distinct Trichoscopic Features of the Sideburns in Frontal Fibrosing Alopecia Compared to the Frontotemporal Scalp. Skin Appendage Disord 2018; 4:50-54. [PMID: 29457017 PMCID: PMC5806192 DOI: 10.1159/000479116] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 06/30/2017] [Indexed: 12/19/2022] Open
Abstract
The trichoscopic features of frontal fibrosing alopecia (FFA) have been described in the frontotemporal area, yet there is no data detailing the trichoscopic features of the sideburns, which can be the initial or exclusive area of involvement. In this retrospective cohort study, 236 trichoscopic images of the frontotemporal and sideburn area obtained via dry trichoscopy from patients with biopsy-proven FFA were examined by two independent researchers to determine the trichoscopic features of FFA in the sideburns. The images of the sideburns were compared to 44 trichoscopic images of 11 healthy volunteers with intact sideburns. Transparent proximal hair emergence surrounded by patches of paler smooth skin was the most prominent finding in the sideburns. Peripilar casts and peripilar erythema were rare in the sideburns compared to the frontotemporal area. Although less common, transparent proximal hair emergence was also seen in the sideburns of healthy controls, yet it was shorter and restricted to individual hairs. Early FFA presenting exclusively or mostly with sideburn involvement should not be missed due to absence of peripilar casts and peripilar erythema. Dermoscopy-guided biopsy obtained from hair shafts with transparent proximal hair emergence should be considered to make the diagnosis in this location.
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Affiliation(s)
- Jessica Cervantes
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
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15
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Pirmez R, Barreto T, Duque-Estrada B, Quintella DC, Cuzzi T. Facial Papules in Frontal Fibrosing Alopecia: Beyond Vellus Hair Follicle Involvement. Skin Appendage Disord 2017; 4:145-149. [PMID: 30197890 DOI: 10.1159/000481695] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 09/19/2017] [Indexed: 11/19/2022] Open
Abstract
Background Frontal fibrosing alopecia (FFA) is considered a variant of lichen planopilaris affecting mainly the frontotemporal hairline. Since the first report in 1994, several other clinical features have been associated with the disease, such as facial papules (FP). Even though FP have been linked to facial vellus hair follicle involvement, how this finding alone could lead to the formation of clinically evident FP in FFA patients had not yet been addressed. Objective To describe histopathological findings of FP in the context of FFA and to highlight features that may be linked to their clinical formation. Methods Cutaneous FP biopsies of FFA patients performed between January 2016 and May 2017 were retrieved from our pathology database and reexamined by 2 pathologists. Results Histological sections of thirteen 3.0-mm punch biopsy specimens (2 horizontally and 11 vertically oriented) were collected from 7 patients. Eleven specimens demonstrated prominent sebaceous glands and 10 dilated sebaceous ducts. Pinkus acid orcein staining revealed reduction and fragmentation of the elastic fibers in 12 samples and, in 7 of these, this finding was observed in both the papillary and reticular dermis, particularly around sebaceous lobules. Vellus hair follicle involvement was only seen in 2 samples. Conclusions Prominent sebaceous lobules with dilated ducts associated with an abnormal elastic framework seem to be the main explanation for the formation of FP in the context of FFA.
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Affiliation(s)
- Rodrigo Pirmez
- Department of Dermatology, Instituto de Dermatologia Professor Rubem David Azulay, Santa Casa da Misericórdia do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Taynara Barreto
- Department of Dermatology, Instituto de Dermatologia Professor Rubem David Azulay, Santa Casa da Misericórdia do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Bruna Duque-Estrada
- Department of Dermatology, Instituto de Dermatologia Professor Rubem David Azulay, Santa Casa da Misericórdia do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Danielle C Quintella
- Department of Dermatology, Instituto de Dermatologia Professor Rubem David Azulay, Santa Casa da Misericórdia do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Tullia Cuzzi
- Department of Dermatology, Instituto de Dermatologia Professor Rubem David Azulay, Santa Casa da Misericórdia do Rio de Janeiro, Rio de Janeiro, Brazil
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16
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Turegano MM, Sperling LC. Lichenoid folliculitis: A unifying concept. J Cutan Pathol 2017; 44:647-654. [PMID: 28345255 DOI: 10.1111/cup.12938] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Revised: 03/13/2017] [Accepted: 03/21/2017] [Indexed: 12/19/2022]
Abstract
Skin diseases presenting with keratotic papules, atrophy, cicatricial alopecia and/or "lichenoid" histopathologic changes have been described under at least 30 names. This family of diseases contains 2 subgroups, largely based on clinical features: keratosis pilaris atrophicans (KPA; including keratosis pilaris atrophicans faciei/ulerythema ophryogenes, atrophoderma vermiculatum, and keratosis follicularis spinulosa decalvans); and the lichen planopilaris (LPP) subgroup (including LPP, frontal fibrosing alopecia, Graham-Little-Piccardi-Lassueur Syndrome and fibrosing alopecia in a pattern distribution). An interface dermatitis with lichenoid inflammation is characteristic of the LPP group of disorders, but the literature provides scant information about the histopathology of the KPA group. Our experience has been that the 2 subgroups show a unifying histologic similarity as well as considerable clinical overlap. Because these conditions overlap clinically and histologically, we propose that the term lichenoid folliculitis (LF) be used to refer to this group of diseases, thus simplifying cumbersome nomenclature and highlighting the possibility of shared pathogenesis and treatment options.
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Affiliation(s)
- Mamina M Turegano
- Department of Pathology and Laboratory Medicine, Division of Dermatopathology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, Maryland
| | - Leonard C Sperling
- Department of Dermatology, Uniformed Services University of the Health Sciences, Los Angeles, Maryland
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17
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Pirmez R, Donati A, Valente NS, Sodré CT, Tosti A. Glabellar red dots in frontal fibrosing alopecia: a further clinical sign of vellus follicle involvement. Br J Dermatol 2014; 170:745-6. [PMID: 24116835 DOI: 10.1111/bjd.12683] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- R Pirmez
- Sector of Dermatology, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
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18
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Jouanique C, Reygagne P. [Frontal fibrosing alopecia]. Ann Dermatol Venereol 2014; 141:272-8. [PMID: 24703641 DOI: 10.1016/j.annder.2014.01.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Revised: 12/03/2013] [Accepted: 01/09/2014] [Indexed: 01/06/2023]
Abstract
Frontal fibrosing alopecia (FFA) was first described in 1994. It is characterized by scarring alopecia in bands involving the anterior area of the scalp. Alopecia of the eyebrows is frequently associated, as are pubic, facial and body hair alopecia. The clinical and histologic features are evocative of lichen planopilaris (LPP), and AFF is in fact regarded as a special pattern of LPP. Histology reveals a lymphocytic infiltrate located around the isthmus and follicular infundibulum associated with a decrease in the number of follicles, which are supplanted by fibrous tract. AFF most commonly affects post-menopausal women, but instances have been described in men and in young women. This orphan disease has increased in recent years, with more than 37 articles dedicated to this condition since it was first described in 1994. The pathophysiology remains unknown. The condition develops slowly with spontaneous stabilization over several years but it is impossible to predict the degree of expression prior to stabilization. In this article we review the various treatments proposed, for none of which formal proof of efficacy has been provided to date.
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Affiliation(s)
- C Jouanique
- Service de dermatologie, hôpital Saint-Louis, 1, avenue Claude-Vellefaux, 75010 Paris, France; Centre Sabouraud, hôpital Saint-Louis, 1, avenue Claude-Vellefaux, 75010 Paris, France
| | - P Reygagne
- Centre Sabouraud, hôpital Saint-Louis, 1, avenue Claude-Vellefaux, 75010 Paris, France.
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19
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Ladizinski B, Bazakas A, Selim MA, Olsen EA. Frontal fibrosing alopecia: a retrospective review of 19 patients seen at Duke University. J Am Acad Dermatol 2013; 68:749-55. [PMID: 23375454 DOI: 10.1016/j.jaad.2012.09.043] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2012] [Revised: 09/10/2012] [Accepted: 09/18/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND Frontal fibrosing alopecia (FFA) is a type of scarring hair loss primarily observed in postmenopausal women and characterized by fronto-tempero-parietal hairline recession, perifollicular erythema, and loss of eyebrows. The incidence is unknown, but the number of women presenting with this condition has significantly increased in recent years. No effective therapy has been established. OBJECTIVE The purpose of this study is to present pertinent demographic and clinical findings of patients with FFA seen at an academic hair loss clinic and their responses to various therapeutic interventions. METHODS Patients seen at the Duke University Hair Disorders Research and Treatment Center, Durham, NC, between 2004 and 2011 who met FFA inclusion criteria and signed an informed consent form for participation in the Duke University Hair Disorders Research and Treatment Center database were included in this review. RESULTS Nineteen female patients with FFA met our inclusion criteria, the majority of whom were white and postmenopausal. A number of treatments, including topical and intralesional steroids, antibiotics, and immunomodulators, were used with disappointing results in most patients. However, the majority of patients on dutasteride experienced disease stabilization. LIMITATIONS This was a retrospective review and outside clinic records were occasionally incomplete. CONCLUSIONS FFA is an increasingly common form of scarring hair loss, but the origin remains unknown. Without clear understanding of the pathogenesis and evolution of this condition, it is not surprising that treatments to date have been minimally or not effective. At our institution, dutasteride was most effective in halting disease progression, although no therapy was associated with significant hair regrowth.
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Affiliation(s)
- Barry Ladizinski
- Hair Disorders Research and Treatment Center, Duke University Medical Center, Durham, North Carolina, USA.
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20
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MacDonald A, Clark C, Holmes S. Frontal fibrosing alopecia: a review of 60 cases. J Am Acad Dermatol 2012; 67:955-61. [PMID: 22503342 DOI: 10.1016/j.jaad.2011.12.038] [Citation(s) in RCA: 134] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2011] [Revised: 11/15/2011] [Accepted: 12/09/2011] [Indexed: 12/19/2022]
Abstract
BACKGROUND Frontal fibrosing alopecia (FFA) is a variant of lichen planopilaris primarily affecting postmenopausal women, with a predilection for the frontotemporal hairline. OBJECTIVES We sought to examine possible causal associations and review the clinical features, natural history, and response to treatment of patients with FFA attending a specialist hair clinic. METHODS This was a case note review of 60 patients with FFA. RESULTS The number of patients with FFA seen has increased over the last decade. All were Caucasian women, with significantly above-average affluence scores and were less likely to be smokers. The mean age at presentation was 64 years and average disease duration was 3.4 years (range: 6 months-30 years). Three patients were premenopausal. All patients had frontotemporal involvement, with follicular hyperkeratosis, scarring, and variable perifollicular erythema. Several patients had more unusual patterns: 8 had extensive parietal involvement, 4 had occipital involvement, 1 had asymmetric frontal involvement, and 5 had typical FFA associated with diffuse scalp lichen planopilaris. Eyebrow loss was documented in 73%, eyelash loss in 3%, and body hair loss in 25%. Almost all patients had been treated with superpotent topical steroids. Other treatments included topical calcineurin inhibitors; intralesional triamcinolone acetate; phototherapy; hydroxychloroquine; lymecycline; and prednisolone. Although some treatments may reduce inflammation, their efficacy in controlling the progress of the alopecia was uncertain. LIMITATIONS This is a retrospective review. CONCLUSIONS FFA is a clinically distinctive condition, the prevalence of which appears to be increasing. It has a generally poor response to treatment. The origin remains uncertain.
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Affiliation(s)
- Alison MacDonald
- Alan Lyell Center for Dermatology, Southern General Hospital, Glasgow, United Kingdom.
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21
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Miteva M, Whiting D, Harries M, Bernardes A, Tosti A. Frontal fibrosing alopecia in black patients. Br J Dermatol 2012; 167:208-10. [PMID: 22229387 DOI: 10.1111/j.1365-2133.2012.10809.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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22
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Abstract
BACKGROUND Scalp biopsies are crucial for the diagnosis of cicatricial alopecia. However, the pathologic interpretation may not be diagnostic if biopsy is not obtained from the correct site. This is particularly relevant for cicatricial alopecia as the disease may be focal and disease activity difficult to appreciate by the naked eye. OBJECTIVE To report a new simple technique to select the optimal biopsy site in cicatricial alopecia. METHODS In the last 2 years we performed dermoscopy guided scalp biopsies using handled dermatoscopes in 80 patients with different forms of cicatricial alopecia. Biopsy site was selected based on presence of the following dermatoscopic features: perifollicular concentric white scales in lichen planopilaris, frontal fibrosing alopecia (FFA) and discoid lupus erythematosus (DLE); hair tufts in folliculitis decalvans, hairs surrounded by a peripilar grey-white halo in central centrifugal cicatricial alopecia and follicular red dots or keratotic plugs in DLE. RESULTS The dermoscopy guided biopsies yielded a definitive pathological diagnosis in 95% of the cases. COMMENT The advantage of this method is that it is a fast, precise way to identify even individually affected follicles in early or focal cicatricial alopecia. It also allows for the morphologic characterization of particular follicular structures.
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Affiliation(s)
- M Miteva
- Department of Dermatology and Cutaneous Surgery, University of Miami, Miller School of Medicine, FL, USA
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23
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Miteva M, Tosti A. The follicular triad: a pathological clue to the diagnosis of early frontal fibrosing alopecia. Br J Dermatol 2011; 166:440-2. [PMID: 21787366 DOI: 10.1111/j.1365-2133.2011.10533.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Miteva M, Aber C, Torres F, Tosti A. Frontal fibrosing alopecia occurring on scalp vitiligo: report of four cases. Br J Dermatol 2011; 165:445-7. [DOI: 10.1111/j.1365-2133.2011.10382.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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