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Resident's Forum
Frontal Fibrosing Alopecia: An Update on Epidemiology and Treatment
FR – Alopecia frontal fibrosante: novedades epidemiológicas y terapéuticas
M. Martínez-Pérez
Corresponding author
mrcl_mtnez@yahoo.es

Corresponding author.
, M. Churruca-Grijelmo
Servicio de Dermatología, Hospital Severo Ochoa, Madrid, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Frontal fibrosing alopecia &#40;FFA&#41; is a type of cicatricial alopecia of unknown origin that mainly affects postmenopausal women&#46; The incidence of FFA has continued to increase since it was first described by Kossard in 1994&#46; Despite growing interest in this condition&#44; many questions on etiology and treatment remain unanswered&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">We would like to draw attention to the largest series of patients to date&#44; which was recently reported by Va&#241;&#243; et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">1</span></a> who compiled 355 cases with striking results&#44; such as an increased incidence of early menopause &#40;14&#37; vs 6&#37; in the general population&#41;&#44; suggesting that low estrogen levels can play a key role in the etiology of the disease&#46; Also noteworthy is the presence of androgenic alopecia in 40&#37; of patients&#44; which was much greater than in other series&#44;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">2</span></a> and of hypothyroidism in 15&#37; &#40;4&#46;2&#37; in the general population&#41;&#44; which also points to a possible hormonal etiology&#46; Findings such as diffuse reduction in body hair &#40;present in 24&#37;&#41;&#44; eyelash loss &#40;14&#37;&#41;&#44; and perifollicular papules on the face &#40;14&#37;&#41; are associated with a poorer prognosis and may indicate the need for systemic treatment&#46; However&#44; eyebrow loss as the first manifestation of FFA seems to be associated with milder forms&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">The modest findings to date on the treatment of FFA are based on meager and poor quality scientific evidence&#46; In the study by Va&#241;&#243; et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">1</span></a> the most effective drugs were the 5-alfa-reductase inhibitors finasteride and dutasteride&#8212;perhaps because of the high prevalence of female androgenetic alopecia in this series&#8212;and intralesional corticosteroids&#46; These data are similar to those reported in a systematic review&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">3</span></a> Therefore&#44; 5-alfa-reductase inhibitors could prove useful as maintenance therapy&#58; they lead to improvement in 45&#37; of patients and stabilization in 53&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">1</span></a> Furthermore&#44; they could be used in cases with concomitant androgenic alopecia&#46; Intralesional corticosteroids would be indicated in conditions such as pruritus&#44; erythema&#44; and perifollicular hyperkeratosis&#44; as they lead to partial improvement in 60&#37; of patients and have proven particularly effective in cases of eyebrow involvement&#44; with responses reported in 80&#37; of cases&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">3</span></a> The efficacy of oral antimalarial drugs is lower &#40;around 30&#37;-40&#37;&#41;&#46; Topical calcineurin inhibitors are considered coadjuvant treatment&#44; and the review cited above considers them to be inefficacious when administered alone&#46; Similarly&#44; efficacy has not been demonstrated with minoxidil&#44; topical corticosteroids&#44; hormone replacement therapy&#44; mycophenolate mofetil&#44; tetracyclines&#44; or systemic corticosteroids&#46; Some of the drugs that proved successful in the treatment of lichen planopilaris&#44; of which FFA is considered a clinical variant&#44;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">4</span></a> may play a role in the treatment of this type of alopecia in the future&#44; especially in refractory cases&#46; Oral ciclosporin led to a response in 60&#37; of patients with lichen planopilaris&#44; although recurrence is frequent once the drug is stopped&#59; therefore&#44; it could be a good candidate for clinical trials involving patients with FFA&#46; Lastly&#44; promising results have been observed in patients with lichen planopilaris treated with rituximab and pioglitazone&#46;</p></span>"
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Article information
ISSN: 15782190
Original language: English
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Idiomas
Actas Dermo-Sifiliográficas
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