Examination of Clinical and Demographic Characteristics of 14 Cases with Frontal Fibrosing Alopecia

Year 2018, Volume: 5 Issue: 1, 110 - 115, 31.01.2018

Ayse Akbas , Fadime Kılınç

https://doi.org/10.17546/msd.379191

Abstract

Objective: Frontal fibrosing alopecia (FFA) is a rare type of cicatricial alopecia seen in postmenopausal women characterized with band-type frontal/frontotemporal hair traction and/or significant or complete loss of the eyebrows. We aimed to present the demographic, clinical and laboratory characteristics of female patients diagnosed and followed-up with FFA in our clinic by comparing these with the literature data. Method: A total of 14 patients who admitted to our outpatient clinic with alopecia on the frontotemporal/frontal hairline and were clinically and/or histopathologically diagnosed with FFA between 2011 and 2016 were evaluated in a retrospective manner. The patients were reviewed in terms of the age of lesion onset, localization, accompanying symptom or disease, and treatment options. Results: The ages of the patients who were followed-up in our outpatient clinic with FFA were between 52 and 73 (mean 2 years). Eight patients (57%) had total eyebrow loss,. Laboratory tests were in normal limits or negative. Comorbidities included thyroid disease, hypertension and coronary artery disease diabetes mellitus. For treatment, all patients were given systemic, intralesional and topical steroid, and topical minoxidil at various times. Four patients received hydroxychloroquine, 2 patients acitretin, 2 patients Vitamin E, 1 patient itraconazole, and 1 patient topical tacrolimus. Conclusion: FFA should be considered in middle aged and elderly postmenopausal women presenting with hair loss complaints and were detected to have frontal hairline traction and cicatricial alopecia, and the diagnosis should be supported by biopsy. Thereby, the disease progression may be prevented or delayed with early diagnosis and proper treatment..

Keywords

Cicatricial alopecia

References

• 1. Kossard S: Postmenopausal frontal fibrosing alopecia scarring alopecia in a pattern distribution.Arch Dermatol 1994;130: 770-4.
• 2. Martínez-Pérez M. Churruca-Grijelmo M:Frontal fibrosing alopecia:an updateon epidemiology and treatment. Actas Dermosifiliograficas 2015;106:757-8.
• 3. Esteban -Lucia L, Molina -Ruiz AM, Requena L: Update on frontal fibrosing alopecia. Actas Dermosifiliograficas 2017;108:293-304.
• 4. Holmes SM: Frontal fibrosing alopecia: Pigmentary Disorders 2017 ; 4:257. doi:10.4172/2376-0427.1000257
• 5. Poblet E, Jiménez F, Pascual A, et al: Frontal fibrosing alopecia versus lichen planopilaris: a clinicopathological study. Int J Dermatol 2006;45:375-80.
• 6. Moreno-Ramirez D, Martinez FC: Frontal fibrosing alopecia: a survey in 16 patients. J Eur Acad Dermatol Venereol 2005;19:700-5.
• 7. Tan KT, Messenger AG: Frontal fibrosing alopecia: clinical presentations and prognosis. Br J Dermatol 2009;160:75-9
• 8. Navarro-Belmonte MR, Navarro-López V, Ramírez-Boscà A, et al: Case series of familial frontal fibrosing alopecia and a review of the literature. J Cosmet Dermatol 2015;14:64-9. doi: 10.1111/jocd.12125.
• 9. Tziotzios C, Stefanato CM, Fenton DA,et al: Frontalfibrosing alopecia: reflections and hypotheses on aetiology and pathogenesis. ExpDermatol 2016 Nov;25:847-852. doi: 10.1111/exd.13071.
• 10. Faulkner CF, Wilson NJ, Jones SK: Frontal fibrosing alopecia associated with cutaneous lichen planus in a premenopausal woman. Australas J Dermatol 2002; 43: 65–7.
• 11. Samrao A, Chew AL, Price V: Frontal fibrosing alopecia: a clinical review of 36 patients. Br J Dermatol 2010;163:1296-1300.
• 12. Ladizinski B, Bazakas A, Selim MA,et al: Frontal fibrosing alopecia: a retrospective review of 19 patients seen at Duke University. J Am Acad Dermatol 2013;68:749-55. doi: 10.1016/j.jaad.2012.09.043.
• 13. MacDonald A, Clark C, Holmes S: Frontal fibrosing alopecia: a review of 60 cases. J Am Acad Dermatol 2012;67:955-61.
• 14. Vano-Galvan S, Molina-Ruiz AM, Serrano-Falcon C, et al: Frontal fibrosing alopecia: a multi center review of 355 patients. J Am Acad Dermatol 2014;70:670-8.
• 15. Banka N, Mubki T, Bunagan MJ, et al: Frontal fibrosing alopecia: A retrospective clinical review of 62 patients with treatment outcome and long-term follow-up. Int J Dermatol 2014;53: 1324-30.
• 16. Kumbasar E, Gokdemir G, Koşlu A: Postmenopozal frontal fibrozan alopesi: olgu sunumu. Turkderm 2006; 40 (Ozel Ek B): 29-30.
• 17. Takçı Z,Baş Y,Arıcı,A : Frontal fibrozan alopesi. J Am Acad Dermatol 2009; 61: 157-8.
• 18. Aksoy B, Balcı M, Ustun H, Şahin S: Frontal fibrozan alopesi. Genel Tıp Derg 2011; 21: 25-8
• 19. Özcan D, Seçkin D, GüleçT,et al. Lichen planopilaris: demographic, clinical and histopathological characteristics and treatment outcomes of 25 cases Turkderm 2015; 49: 246-252 | DOI: 10.4274/turkderm.32767
• 20. Kossard S, Lee M-S, Wilkinson B: Postmenopausal frontal fibrosing alopecia: a frontal variant of lichen planopilaris. J Am Acad Dermatol 1997;36:59-66.
• 21. Stockmeier M, Kunte C, Sander CA,et al: Kossard frontal fibrosing alopecia in a man. (German ) Hautarzt 2002;53:409–11.
• 22. Ramaswamy P, Mendese G, Goldberg LJ. Scarring alopecia of the sideburns: a unique presentation of frontal fibrosing alopecia in men. Arch Dermatol 2012; 148: 1095-96
• 23. Tosti A, Piraccini BM, Iorozzo M,et al:Frontal fibrosing alopecia in post-menopausal women. J Am Acad Dermatol 2005; 52: 55-60.
• 24. Harries MJ, Trueb RM, Tosti A, et al: How not to get scar(r)ed: pointers to the correct diagnosis in patients with suspected primary cicatricial alopecia. Br J Dermatol 2009 ;160:482-501. doi: 10.1111/j.1365-2133.2008.09008.x
• 25. Mirmirani P, Willey A, Headington JT,et al: Primary cicatricial alopecia: histopathologic findings do not distinguish clinical variants. J Am Acad Dermatol 2005;52:637-43.
• 26. Rácz E, Gho C, Moorman PW, et al: Treatment of frontal fibrosing alopecia and lichen planopilaris: a systematic review. J Eur Acad Dermatol Venereol 2013; 27: 1461-70.
• 27. Filbrandt R , Rufaut N , Jones L,et al: Primary cicatricial alopecia: diagnosis and treatment. CMAJ 2013 ;185: 1579–85.
• 28. Georgala S, Katoulis AC, Befon A, et al: Treatment of postmenopausal frontal fibrosing alopecia with oral dutasteride. J Am Acad Dermatol 2009;61:157-8