Conflicts of interest None declared.
Frontal fibrosing alopecia: a clinical review of 36 patients
Article first published online: 2 AUG 2010
© 2010 The Authors. BJD © 2010 British Association of Dermatologists
British Journal of Dermatology
Volume 163, Issue 6, pages 1296–1300, December 2010
How to Cite
Samrao, A., Chew, A.-L. and Price, V. (2010), Frontal fibrosing alopecia: a clinical review of 36 patients. British Journal of Dermatology, 163: 1296–1300. doi: 10.1111/j.1365-2133.2010.09965.x
- Issue published online: 18 NOV 2010
- Article first published online: 2 AUG 2010
- Accepted manuscript online: 2 AUG 2010 12:00AM EST
- Accepted for publication 27 April 2010
- frontal fibrosing alopecia;
- Lichen Planopilaris Activity Index;
- mycophenolate mofetil;
- retrospective review
Background Frontal fibrosing alopecia (FFA) is a primary lymphocytic cicatricial alopecia with a distinctive clinical pattern of progressive frontotemporal hairline recession. Currently, there are no evidence-based studies to guide treatment for patients with FFA; thus, treatment options vary among clinicians.
Objectives We report clinical findings and treatment outcomes of 36 patients with FFA, the largest cohort to date. Further, we report the first evidence-based study of the efficacy of hydroxychloroquine in FFA using a quantitative clinical score, the Lichen Planopilaris Activity Index (LPPAI).
Methods A retrospective case note review was performed of 36 adult patients with FFA. Data were collected on demographics and clinical findings. Treatment responses to hydroxychloroquine, doxycycline and mycophenolate mofetil were assessed using the LPPAI. Adverse events were monitored.
Results Most patients in our cohort were female (97%), white (92%) and postmenopausal (83%). Apart from hairline recession, 75% also reported eyebrow loss. Scalp pruritus (67%) and perifollicular erythema (86%) were the most common presenting symptom and sign, respectively. A statistically significant reduction in signs and symptoms in subjects treated with hydroxychloroquine (P < 0·05) was found at both 6- and 12-month follow up.
Conclusions In FFA, hairline recession, scalp pruritus, perifollicular erythema and eyebrow loss are common at presentation. Despite the limitations of a retrospective review, our data reveal that hydroxychloroquine is significantly effective in reducing signs and symptoms of FFA after both 6 and 12 months of treatment. However, the lack of a significant reduction in signs and symptoms between 6 and 12 months indicates that the maximal benefits of hydroxychloroquine are evident within the first 6 months of use.