1
|
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.
Collapse
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
| |
Collapse
|
2
|
Landau M, Tosti A, Kroumpouzos G, Eims E, Goldust M. Frontal fibrosing alopecia-A new absolute contraindication for deep chemical peels. Clin Dermatol 2024:S0738-081X(24)00109-3. [PMID: 38942154 DOI: 10.1016/j.clindermatol.2024.06.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/30/2024]
Abstract
Frontal fibrosing alopecia (FFA) is characterized by a receding hairline in the frontotemporal region due to the gradual loss of hair follicles and then follicular stem cells and follicular fibrosis. Follicular stem cells are crucial in skin healing after chemical peeling and other resurfacing procedures. Although there is a possible association of FFA with a history of facial and scalp surgical procedures, there is no information on the safety of cosmetic procedures in patients with FFA. We report five patients with FFA who experienced unusual and complicated outcomes after undergoing a deep chemical peel (phenol and croton oil). As the prevalence of FFA continues to increase globally, it is essential to raise awareness about the potential incompatibility of this dermatologic disorder with specific cosmetic procedures, such as deeper peels and other resurfacing modalities.
Collapse
Affiliation(s)
| | - Antonella Tosti
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | | | - Erik Eims
- Aesthetic Medicine and Minimally Invasive Surgery Clinic, Tel Aviv, Israel
| | - Mohamad Goldust
- Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut, USA
| |
Collapse
|
3
|
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.
Collapse
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
| |
Collapse
|
4
|
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.
Collapse
Affiliation(s)
| | - Anna Woźniacka
- Department of Dermatology and Venereology, Medical University of Lodz, Hallera 1, 90-647 Lodz, Poland;
| |
Collapse
|
5
|
Pastor-Nieto MA, Gatica-Ortega ME, Borrego L. Sensitisation to ethylhexyl salicylate: Another piece of the frontal fibrosing alopecia puzzle. Contact Dermatitis 2024; 90:402-410. [PMID: 38010086 DOI: 10.1111/cod.14463] [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: 08/05/2023] [Revised: 11/05/2023] [Accepted: 11/08/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND There is speculation that some environmental factors may be impacting the increasing incidence of frontal fibrosing alopecia (FFA). In a recent publication, sensitisation to benzyl salicylate was shown to be prevalent among 36 patients with FFA. Ethylhexyl salicylate (EHS), a light stabiliser, ultraviolet (UV) B absorber and UV filter, frequently found in photoprotectors/cosmetics and, rarely reported as a sensitiser, was not patch tested in said research. METHODS From January 2021 to February 2022, 33 patients with FFA were patch-tested with the European Photopatch Series, including EHS 10% pet. in two hospitals. In addition, we conducted a literature review and a market survey. RESULTS Patch test reactions to EHS were identified in 9 of 33 (27.3%). Four of nine also reacted to their personal sunscreens (containing EHS). All involved women with a mean age of 54 (30-65). Five patients had been diagnosed with FFA before the patch tests; and, four were diagnosed with FFA during the patch test investigations. CONCLUSION Sensitisation to EHS was frequently found in a selected population of patients with FFA. We propose to expand the spectrum of contact allergens described in patients with FFA to include EHS and discuss the possible need for optimization of the patch test preparation.
Collapse
Affiliation(s)
- María Antonia Pastor-Nieto
- Dermatology Department, Hospital Universitario de Guadalajara, Guadalajara, Spain
- Dermatology Department, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
- Medicine and Medical Specialties Department, Faculty of Medicine and Health Sciences, Universidad de Alcalá, Alcalá de Henares, Spain
- Universidad de Castilla-La-Mancha, Toledo, Spain
| | - María Elena Gatica-Ortega
- Universidad de Castilla-La-Mancha, Toledo, Spain
- Dermatology Department, Complejo Hospitalario Universitario de Toledo, Toledo, Spain
| | - Leopoldo Borrego
- Dermatology Department, Universidad de Las Palmas de Gran Canaria, Hospital Universitario Insular, Las Palmas de Gran Canaria, Spain
| |
Collapse
|
6
|
Saber M, Farokhshahi M, Fatemi Naeini F, Mohaghegh F, Asilian A. Clinical effectiveness of finasteride versus hydroxychloroquine in the treatment of frontal fibrosing alopecia: A randomized controlled trial. J Cosmet Dermatol 2024; 23:576-584. [PMID: 37691183 DOI: 10.1111/jocd.15993] [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: 05/18/2023] [Revised: 07/04/2023] [Accepted: 08/29/2023] [Indexed: 09/12/2023]
Abstract
BACKGROUND Frontal fibrosing alopecia (FFA) is a cicatricial alopecia with rapid epidemic growth. However, there is no agreement on the best therapeutic approach. AIMS To compare the therapeutic effects of finasteride as a first-line systemic treatment of FFA versus hydroxychloroquine as a relatively safe and effective immunosuppressive drug. METHODS Thirty-four female FFA patients were randomly assigned to receive either 400 mg/day of hydroxychloroquine or 2.5 mg/day of finasteride for 6 months. Topical treatments in both groups include pimecrolimus, mometasone, and minoxidil. Treatment efficacy was evaluated using the Frontal Fibrosing Alopecia Severity Score (FFASS), photography, and trichoscopy after 3 and 6 months. RESULTS Both the finasteride and hydroxychloroquine groups showed significant improvements in FFASS and trichoscopic scores (p < 0.01). However, there was no significant difference between the two groups during the study. Photographic assessment showed that more than 60% of patients in both groups had improved without statistically significant differences between the two groups. CONCLUSIONS Both finasteride and hydroxychloroquine are equally effective, safe, and well-tolerable for treating FFA patients.
Collapse
Affiliation(s)
- Mina Saber
- Department of Dermatology, Skin Diseases and Leishmaniasis Research Center, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Maryam Farokhshahi
- Department of Dermatology, Skin Diseases and Leishmaniasis Research Center, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Farahnaz Fatemi Naeini
- Department of Dermatology, Skin Diseases and Leishmaniasis Research Center, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fatemeh Mohaghegh
- Department of Dermatology, Skin Diseases and Leishmaniasis Research Center, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ali Asilian
- Department of Dermatology, Skin Diseases and Leishmaniasis Research Center, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| |
Collapse
|
7
|
Nasimi M, Ansari MS. JAK Inhibitors in the Treatment of Lichen Planopilaris. Skin Appendage Disord 2024; 10:10-17. [PMID: 38313572 PMCID: PMC10836856 DOI: 10.1159/000534631] [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: 06/10/2023] [Accepted: 10/11/2023] [Indexed: 02/06/2024] Open
Abstract
Background Lichen planopilaris (LPP) is an autoimmune disorder leading to lymphocytic cicatricial alopecia. Different agents such as hydroxychloroquine, methotrexate, cyclosporine, and mycophenolate mofetil have been tried to control hair loss with limited efficacy. JAK inhibitors are immune-modulating drugs which interfere with the JAK-STAT signaling pathway in lymphocytes and are used in treatment of inflammatory conditions such as rheumatoid arthritis and alopecia areata. Summary Our aim was to determine effectiveness of JAK inhibitors in LPP and its clinical variant, frontal fibrosing alopecia. A literature search was conducted using PubMed, Google Scholar, and Cochrane databases. A total of 7 articles describing 35 patients were found. Although data on treatment are limited to retrospective studies and case reports, JAK inhibitors can be considered a new therapeutic option, especially in recalcitrant cases. Large prospective studies and randomized control trials are needed to provide further evidence supporting efficacy. Key Messages Besides the fact that data on the treatment of LPP and FFA with JAK inhibitors are limited to retrospective studies and case reports, but JAK inhibitors can be considered as a new therapeutic option especially in recalcitrant cases.
Collapse
Affiliation(s)
- Maryam Nasimi
- Autoimmune Bullous Disease Research Center, Department of Dermatology, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahshid Sadat Ansari
- Autoimmune Bullous Disease Research Center, Department of Dermatology, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
8
|
Verma S, Marak A, Paul D, Dey B. A Retrospective Study of Frontal Fibrosing Alopecia from North-East India. Indian J Dermatol 2023; 68:598-602. [PMID: 38371592 PMCID: PMC10868975 DOI: 10.4103/ijd.ijd_290_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2024] Open
Abstract
Background Frontal fibrosing alopecia (FFA) is an important cause of scarring alopecia seen mostly in post-menopausal women but sometimes in pre-menopausal women and men. Although considered a variant of lichen planopilaris due to its histopathological characteristics, it has distinct clinical features and associations, which make it a unique entity. We hereby report a series of patients with FFA from North-East India. Aims and Objective This study aimed to analyse the clinical and histopathological characteristics of FFA. Materials and Methods We retrospectively analysed clinical records and histopathological features of FFA cases diagnosed in the Dermatology Outpatient Department from April 2013 to February 2023. Results A total of 21 patients, who were diagnosed with FFA from April 2013 to February 2023, were analysed. Of these, 19 patients were female, with a male-to-female ratio of 9.5:1. The mean age of study population was 48.33 years. The majority of the patients were from the post-menopausal age group (15/19 females, 78.94%). Lichen planus pigmentosus (6, 28.57%) was the most commonly associated disease, followed by androgenetic alopecia and lichen planopilaris (2 each, 9.52%). The main histological features noted were perifollicular lymphocytic infiltrate in 18 (85.71%), followed by hydropic degeneration of basal follicular keratinocytes in 15 (71.42%) and melanin incontinence in 14 (66.66%) patients. Conclusion Our study is the first study from North-East India focusing on the clinical presentation and histopathological characteristics of FFA. Furthermore, with respect to the recent development in FFA, our study attempted to determine the clinical significance of the proposed criteria for the diagnosis of FFA patients by Tolkachjov et al. (2018), viz. International FFA Cooperative Group Criteria (2021).
Collapse
Affiliation(s)
- Shikha Verma
- From the Department of Dermatology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, Meghalaya, India
| | - Anita Marak
- From the Department of Dermatology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, Meghalaya, India
| | - Debopriya Paul
- From the Department of Dermatology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, Meghalaya, India
| | - Biswajit Dey
- Department of Pathology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, Meghalaya, India
| |
Collapse
|
9
|
Starek JV, Raszl TP, Kaddourah SMEH. Frontal fibrosing alopecia: report of four sisters. An Bras Dermatol 2023; 98:855-858. [PMID: 37468416 PMCID: PMC10589475 DOI: 10.1016/j.abd.2022.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 02/18/2022] [Accepted: 02/21/2022] [Indexed: 07/21/2023] Open
Affiliation(s)
| | - Thaís Petry Raszl
- Department of Dermatology, Complexo Hospitalar Padre Bento, Guarulhos, SP, Brazil
| | | |
Collapse
|
10
|
Dunn C, Griffith V, Coican A, Dane A, Chow W, Aneja S, Nathoo R, Leavitt A, Hawkins SD. Janus kinase inhibition for the treatment of refractory frontal fibrosing alopecia: A case series and review of the literature. JAAD Case Rep 2023; 40:47-52. [PMID: 37701887 PMCID: PMC10493233 DOI: 10.1016/j.jdcr.2023.07.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/14/2023] Open
Affiliation(s)
- Charles Dunn
- Department of Dermatology, KCU – GME/ADCS Consortium, Maitland, Florida
| | - Victoria Griffith
- Department of Graduate Medical Education, Memorial Healthcare, Pembroke Pines, Florida
| | - Alexis Coican
- Department of Graduate Medical Education, Orange Park Medical Center, Orange Park, Florida
| | - Alexander Dane
- Department of Dermatology, KCU – GME/ADCS Consortium, Maitland, Florida
| | - William Chow
- Department of Dermatology, KCU – GME/ADCS Consortium, Maitland, Florida
| | - Savina Aneja
- Department of Dermatology, KCU – GME/ADCS Consortium, Maitland, Florida
| | - Rajiv Nathoo
- Department of Dermatology, KCU – GME/ADCS Consortium, Maitland, Florida
| | - Adam Leavitt
- Department of Dermatology, KCU – GME/ADCS Consortium, Maitland, Florida
| | | |
Collapse
|
11
|
Oulad Ali S, Belcadi J, El Hilali S, Senouci K, Meziane M. Frontal fibrosing alopecia and comorbidities in a Moroccan population. JAAD Int 2023; 12:37-38. [PMID: 37274389 PMCID: PMC10238759 DOI: 10.1016/j.jdin.2023.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023] Open
Affiliation(s)
- Sara Oulad Ali
- Department of Dermatology, Mohammed V University in Rabat, Ibn Sina University Hospital, Rabat, Morocco
| | - Jihane Belcadi
- Department of Dermatology, Mohammed V University in Rabat, Ibn Sina University Hospital, Rabat, Morocco
| | - Samia El Hilali
- Community Medicine Laboratory (Public Health, Preventive Medicine, Hygiene), Mohammed V University in Rabat, Ibn Sina University Hospital, Rabat, Morocco
| | - Karima Senouci
- Department of Dermatology, Mohammed V University in Rabat, Ibn Sina University Hospital, Rabat, Morocco
| | - Marieme Meziane
- Department of Dermatology, Mohammed V University in Rabat, Ibn Sina University Hospital, Rabat, Morocco
| |
Collapse
|
12
|
Pinedo-Moraleda F, Tristán-Martín B, Dradi GG. Alopecias: Practical Tips for the Management of Biopsies and Main Diagnostic Clues for General Pathologists and Dermatopathologists. J Clin Med 2023; 12:5004. [PMID: 37568407 PMCID: PMC10419566 DOI: 10.3390/jcm12155004] [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: 07/06/2023] [Revised: 07/21/2023] [Accepted: 07/27/2023] [Indexed: 08/13/2023] Open
Abstract
Accurately diagnosing specific variants of alopecia remains challenging for pathologists, potentially delaying appropriate therapeutic decisions by dermatologists. Issues such as limited knowledge on optimal biopsy types and processing methods add complexity. Understanding the normal histology of hair follicles and their changes throughout the follicular cycle further complicates microscopic evaluation. This paper aims to summarize these characteristics and highlight essential diagnostic clues for pathologists to confidently suggest a diagnosis, therefore playing a key role in alopecia diagnosis. Ongoing education, collaboration with dermatologists, and staying up to date on advancements is crucial for the accurate diagnosis and effective management of different types of alopecia.
Collapse
Affiliation(s)
| | - Belén Tristán-Martín
- Department of Pathology, Hospital Nuestra Señora de Sonsoles, 05004 Avila, Spain;
| | - Giulia Greta Dradi
- Department of Dermatology, Hospital Universitario Fundacion Alcorcon, 28922 Alcorcon, Spain;
| |
Collapse
|
13
|
Kaiser M, Abdin R, Yaghi M, Gaumond SI, Jimenez JJ, Issa NT. Beard Alopecia: An Updated and Comprehensive Review of Etiologies, Presentation and Treatment. J Clin Med 2023; 12:4793. [PMID: 37510908 PMCID: PMC10381635 DOI: 10.3390/jcm12144793] [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: 06/14/2023] [Revised: 07/15/2023] [Accepted: 07/16/2023] [Indexed: 07/30/2023] Open
Abstract
Facial hair is an important social and psychologic aspect of clinical appearance for men. The purpose of this review is to provide a comprehensive overview of the causes of alopecia of the beard including the prevalence, pathophysiology, clinical presentation, and treatment. In this review, we highlight more common causes of beard alopecia including alopecia areata and pseudofolliculitis barbae, infectious causes such as tinea barbae and herpes simplex folliculitis, and rare causes including dermatopathia pigmentosa reticularis and frontal fibrosing alopecia. This review serves as an important resource for clinicians when faced with patients suffering from beard alopecia.
Collapse
Affiliation(s)
- Michael Kaiser
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Rama Abdin
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL 33431, USA
| | - Marita Yaghi
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Simonetta I Gaumond
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Joaquin J Jimenez
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Naiem T Issa
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL 33136, USA
- Forefront Dermatology, Vienna, VA 22182, USA
- Issa Research and Consulting, LLC, Springfield, VA 22152, USA
| |
Collapse
|
14
|
Bobeica C, Niculet E, Craescu M, Parapiru EL, Corduneanu-Luca AM, Debita M, Pelin AM, Tiutiuca C, Vasile CI, Nicolescu AC, Miulescu M, Balan G, Tatu AL. Immunologic and nonimmunologic sclerodermal skin conditions - review. Front Immunol 2023; 14:1180221. [PMID: 37600771 PMCID: PMC10432860 DOI: 10.3389/fimmu.2023.1180221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 05/16/2023] [Indexed: 08/22/2023] Open
Abstract
Scleroderma-like cutaneous lesions have been found in many pathological conditions and they have the clinical appearance of sclerotic or scleroatrophic lesions. Affected skin biopsies described histopathological changes similar to those of scleroderma located strictly on the skin or those of systemic sclerosis. These skin lesions can be found in inflammatory diseases with autoimmune substrate (generalized morphea, chronic graft versus host disease, eosinophilic fasciitis), tissue storage diseases (scleredema, scleromyxedema, nephrogenyc systemic fibrosis, systemic amyloidosis), metabolic diseases (porphyrya cutanea tarda, phenylketonuria, hypothyroidism, scleredema diabeticorum), progeroid syndromes. Given the multiple etiologies of sclerodermal lesions, a correct differential diagnosis is necessary to establish the appropriate treatment.
Collapse
Affiliation(s)
- Carmen Bobeica
- Department of Morphological and Functional Sciences, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galaţi, Romania
| | - Elena Niculet
- Department of Morphological and Functional Sciences, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galaţi, Romania
- Multidisciplinary Integrated Center of Dermatological Interface Research MIC-DIR (Centrul Integrat Multidisciplinar de Cercetare de Interfata Dermatologica - CIM-CID), “Dunărea de Jos” University, Galaţi, Romania
| | - Mihaela Craescu
- Department of Morphological and Functional Sciences, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galaţi, Romania
- Multidisciplinary Integrated Center of Dermatological Interface Research MIC-DIR (Centrul Integrat Multidisciplinar de Cercetare de Interfata Dermatologica - CIM-CID), “Dunărea de Jos” University, Galaţi, Romania
| | - Elena-Laura Parapiru
- Clinical Medical Department, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galaţi, Romania
| | | | - Mihaela Debita
- Clinical Medical Department, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galaţi, Romania
| | - Ana Maria Pelin
- Department of Pharmaceutical Sciences, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galaţi, Romania
| | - Carmen Tiutiuca
- Clinical Surgical Department, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galaţi, Romania
| | - Claudiu Ionut Vasile
- Clinical Medical Department, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galaţi, Romania
| | - Alin Codrut Nicolescu
- Dermatology Department “Agrippa Ionescu” Emergency Clinical Hospital, Bucharest, Romania
| | - Magdalena Miulescu
- Department of Morphological and Functional Sciences, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galaţi, Romania
| | - Gabriela Balan
- Clinical Medical Department, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galaţi, Romania
- Research Center in the Field of Medical and Pharmaceutical Sciences, “Dunărea de Jos” University, Galaţi, Romania
| | - Alin Laurentiu Tatu
- Multidisciplinary Integrated Center of Dermatological Interface Research MIC-DIR (Centrul Integrat Multidisciplinar de Cercetare de Interfata Dermatologica - CIM-CID), “Dunărea de Jos” University, Galaţi, Romania
- Clinical Medical Department, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galaţi, Romania
- Dermatology Department, “Sf. Cuvioasa Parascheva” Clinical Hospital of Infectious Diseases, Galaţi, Romania
| |
Collapse
|
15
|
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.
Collapse
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
| |
Collapse
|
16
|
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.
Collapse
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
| |
Collapse
|
17
|
Exploring potential decreasing age of patients with frontal fibrosing alopecia. JAAD Int 2022; 9:28-29. [PMID: 36034744 PMCID: PMC9411657 DOI: 10.1016/j.jdin.2022.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
|
18
|
Liu L, Chen Y, Chen J, Xue Y, Chen T, Li Y, Shao X, Chen J. Association between frontal fibrosing Alopecia and Rosacea: Results from clinical observational studies and gene expression profiles. Front Immunol 2022; 13:985081. [PMID: 36091020 PMCID: PMC9448884 DOI: 10.3389/fimmu.2022.985081] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 08/10/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundIn recent years, frontal fibrosing alopecia (FFA), a type of scarring alopecia, has attracted increasing attention. Several studies have reported the frequent occurrence of rosacea in FFA; however, the association between FFA and rosacea and the underlying pathogenesis have not been thoroughly clarified. Thus, this study aimed to quantify these relationships and investigate their shared molecular mechanisms.MethodsWe evaluated the association between FFA and rosacea by analyzing clinical data from nine observational studies. We then analyzed the gene expression profiles of FFA and rosacea. First, differential expression analysis and weighted gene co-expression network analysis were used to identify the common differentially expressed genes (DEGs). Later, we conducted a functional enrichment analysis and protein-protein interaction network and used seven algorithms to identify hub genes. Then, we performed a correlation analysis between the hub genes and the gene set variation analysis scores of common pathways in the gene set enrichment analysis (GSEA). The results were validated using different datasets. Finally, transcription factors were predicted and verified, and CIBERSORT and single-sample GSEA were used to estimate the infiltrating immune cells.ResultsPatients with FFA had significantly higher odds for rosacea (pooled odds ratio [OR], 2.46; 95% confidence interval [CI], 1.78–3.40), and the pooled prevalence of rosacea in patients with FFA was 23% (95% CI, 14–23%). Furthermore, we identified 115 co-DEGs and 13 hub genes (CCR5, CCL19, CD2, CD38, CD83, CXCL8, CXCL9, CXCL10, CXCL11, CXCR4, IRF1, IRF8, and PTPRC). Seven pathways showed a high correlation with these hub genes. In addition, one TF, STAT1, was highly expressed in both diseases, and the results of the immune infiltration analysis indicated the importance of M1 macrophages and effector memory CD8+ T cells.ConclusionThis study contributes to the understanding of the relationship between FFA and rosacea, and based on the hub genes, we reveal the potential pathologies shared by the two diseases. This finding provides new insights of underlying molecular mechanisms and it may inspire future research on this comorbidity.
Collapse
Affiliation(s)
- Lin Liu
- Department of Dermatology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yangmei Chen
- Department of Dermatology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jiayi Chen
- Department of Dermatology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yuzhou Xue
- Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital, Beijing, China
| | - Tingqiao Chen
- Department of Dermatology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yuxin Li
- Department of Dermatology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xinyi Shao
- Department of Dermatology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jin Chen
- Department of Dermatology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- *Correspondence: Jin Chen,
| |
Collapse
|
19
|
Porriño-Bustamante ML, Montero-Vílchez T, Pinedo-Moraleda FJ, Fernández-Flores Á, Fernández-Pugnaire MA, Arias-Santiago S. Frontal Fibrosing Alopecia and Sunscreen Use: A Cross-sectional Study of Actinic Damage. Acta Derm Venereol 2022; 102:adv00757. [PMID: 35604235 PMCID: PMC9609976 DOI: 10.2340/actadv.v102.306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Patients with frontal fibrosing alopecia report higher rates of sunscreen use than control subjects. However, it is not known whether the higher use of sunscreens is a cause or a consequence of the alopecia. A greater use of sunscreens should be associated with a lower incidence of signs of actinic damage. The aim of this study is to assess the presence of actinic damage in patients with frontal fibrosing alopecia. A cross-sectional study was carried out on 101 patients with frontal fibrosing alopecia and 40 control subjects. The presence of actinic damage, in the form of solar lentigines, actinic keratoses, and basal and squamous cell carcinomas, was recorded in both groups, together with sunscreen use. Trichoscopy and skin biopsy were performed on patients. Actinic damage was present more frequently in patients with frontal fibrosing alopecia (69.3%) than in control subjects (50%) (p = 0.031). Patients used sunscreens more frequently than did control subjects (83.2% vs 62.5%, p = 0.008). However, the prevalence of trichoscopic inflammatory signs, peripheral alopecia, and inflammatory infiltrate and sebaceous gland involvement in skin biopsy, were similar in patients who used sunscreens and those who did not use them. In conclusion, patients with frontal fibrosing alopecia had greater actinic damage than did control subjects, and this is hypothesized as a reason for the higher use of sunscreens among patients. Thus, use of sunscreens may not be the trigger for frontal fibrosing alopecia that dermatologists have proposed.
Collapse
Affiliation(s)
| | - Trinidad Montero-Vílchez
- Dermatology Department, University Hospital Virgen de las Nieves, Avenida de Madrid, 15, ES-18012, Granada, Spain.
| | | | | | | | | |
Collapse
|
20
|
Ramírez-Marín HA, Tosti A. Examining the autoimmune aspects of frontal fibrosing alopecia. Expert Rev Clin Immunol 2022; 18:1091-1094. [PMID: 35904171 DOI: 10.1080/1744666x.2022.2106971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
| | - Antonella Tosti
- Dr. Philip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida.
| |
Collapse
|
21
|
Porriño-Bustamante ML, Pinedo-Moraleda FJ, Fernández-Flores Á, Montero-Vílchez T, Fernández-Pugnaire MA, Arias-Santiago S. Frontal Fibrosing Alopecia: A Histopathological Comparison of the Frontal Hairline with Normal-Appearing Scalp. J Clin Med 2022; 11:jcm11144121. [PMID: 35887885 PMCID: PMC9323095 DOI: 10.3390/jcm11144121] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 06/23/2022] [Accepted: 07/14/2022] [Indexed: 02/04/2023] Open
Abstract
Frontal fibrosing alopecia is characterized by the presence of a lymphocytic inflammatory infiltrate around the upper follicle and by perifollicular fibrosis, which results in the destruction of the hair follicle. Recent reports have also found the presence of those findings in clinically unaffected areas. The aim of this report is to perform a deeper analysis of the histopathological features of this apparently unaffected scalp. A cross-sectional study including 52 women with frontal fibrosing alopecia was performed. Two areas were biopsied: the frontal hairline and a normal-appearing scalp area. Sebaceous glands were reduced/absent in 80.8% of the frontal hairline samples compared to 42.3% of the "healthy scalp" samples (p = 0.001). Inflammatory infiltrate was observed in 92.3% of patients in the frontal hairline and in 86.5% of them in the "healthy scalp" area (p = 0.508), although the severity was higher in the former (p = 0.013). Follicular epithelium changes were seen in 70.6% of the frontal hairline biopsies compared to 48.1% of the "healthy scalp" biopsies (p = 0.012). Fibrous tissular changes were noted in 80.8% and 53.8% of the frontal hairline and "healthy scalp" biopsies, respectively (p = 0.003). In conclusion, the histopathological features of frontal fibrosing alopecia are shared by both affected and clinically unaffected areas.
Collapse
Affiliation(s)
- María Librada Porriño-Bustamante
- Dermatology Department, University Hospital La Zarzuela, 28023 Madrid, Spain
- Dermatology Department, University of Granada, 18016 Granada, Spain
| | | | | | | | | | - Salvador Arias-Santiago
- Dermatology Department, University Hospital Virgen de las Nieves, 18014 Granada, Spain
- School of Medicine, Institute of Biosanitary Investigation (IBS), Granada University, 18016 Granada, Spain
| |
Collapse
|
22
|
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.
Collapse
|
23
|
Frioui R, Mokni S, Tabka M, Belajouza C, Denguezli M. Frontal fibrosing alopecia following beta blocker injectable mesotherapy: Is it more than a simple coincidence? Dermatol Ther 2021; 35:e15206. [PMID: 34783409 DOI: 10.1111/dth.15206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 10/11/2021] [Accepted: 11/13/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Refka Frioui
- Department of Dermatology, Farhad Hachad Hospital, Sousse, Tunisia
| | - Sana Mokni
- Department of Dermatology, Farhad Hachad Hospital, Sousse, Tunisia
| | - Mariam Tabka
- Department of Dermatology, Farhad Hachad Hospital, Sousse, Tunisia
| | | | | |
Collapse
|
24
|
Heymann WR. Confronting frontal fibrosing alopecia. J Am Acad Dermatol 2021; 85:319-320. [PMID: 34033818 DOI: 10.1016/j.jaad.2021.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 05/11/2021] [Indexed: 10/21/2022]
|