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Frontal fibrosing alopecia: a retrospective clinical review of 62 patients with treatment outcome and long-term follow-up

Authors

  • Nusrat Banka MD,

    1. Department of Dermatology and Skin Sciences, University of British Columbia, Vancouver, BC, Canada
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  • Thamer Mubki MD,

    1. Department of Dermatology and Skin Sciences, University of British Columbia, Vancouver, BC, Canada
    2. Department of Dermatology, Al Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh, Saudi Arabia
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  • Marry Jo Kristine Bunagan MD,

    1. Department of Dermatology and Skin Sciences, University of British Columbia, Vancouver, BC, Canada
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  • Kevin McElwee PhD,

    1. Department of Dermatology and Skin Sciences, University of British Columbia, Vancouver, BC, Canada
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  • Jerry Shapiro MD, FRCPC

    Corresponding author
    1. Department of Dermatology and Skin Sciences, University of British Columbia, Vancouver, BC, Canada
    • Correspondence

      Jerry Shapiro, md, frcpc

      Department of Dermatology and Skin Sciences

      University of British Columbia

      835 W, 10th Avenue

      Vancouver, BC V5Z1L8

      Canada

      E-mail: jerry.shapiro@vch.ca

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  • Conflicts of interest: N.B., T.M. and M.J.K.B. have no conflicts of interest. J.S. and K.M. are consultants for and have received stock and options from Replicel Life Sciences Inc.

Abstract

Background

Frontal fibrosing alopecia is a distinctive form of scarring alopecia presenting with frontal and temporoparietal recession of the hairline. Its etiology remains unknown, and there are no universal treatment guidelines. We conducted a retrospective cohort study to define the clinical findings and treatment outcomes of 62 patients with frontal fibrosing alopecia, one of the largest cohorts to date.

Methods

Data analysis from case notes was performed on 62 patients with a diagnosis of frontal fibrosing alopecia seen from January 2004 to March 2012.

Results

Except for one male, all patients in this cohort were females (80% post-menopausal) and mostly Caucasians (81%). Age at onset was between 18 and 81 years. While 35% reported no symptoms, the majority (65%) had itching, pain, or burning sensations. All patients had frontal hairline recession, and 81% had complete or partial loss of eyebrows. Perifollicular erythema and perifollicular hyperkeratosis occurred in 73% and 31%, respectively. Associated autoimmune connective tissue diseases were observed in 14% of patients. Reduction in symptoms and hairline stabilization were achieved in 97% of treated patients with intralesional corticosteroids. Thirty-one percent of patients were able to stop treatments and remained in remission for six months to six years.

Conclusion

Frontal fibrosing alopecia is increasingly seen in postmenopausal women and rarely in men. Despite the limitations of a retrospective study, we conclude early intervention and treatment with intralesional triamcinolone acetonide may halt the progression of the disease; however, further controlled prospective studies are needed to establish treatment guidelines for frontal fibrosing alopecia.

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