Predictive Factors of Progression in Frontal Fibrosing Alopecia

  • Isabela o Tavares de Figueired Serviço de Dermatologia, Hospital Heliópolis – São Paulo, Brasil
  • Rui Oliveira Soares Serviço de Dermatologia, Hospital CUF Descobertas – Lisboa, Portugal
Keywords: Alopecia, Disease Progression, Facial Dermatoses, Fibrosis


Frontal fibrosing alopecia is a lymphocytic cicatricial alopecia characterized by progressive, symmetrical frontoparietal recess usually accompanied by loss of eyebrows. The etiology is unknown but hormonal factors may be implicated, as it is more prevalent in women (particularly among postmenopausal women) as well as environmental factors (all cases were reported in the last decades). Its increasing incidence and the irreversibility of this alopecia make it crucial to detect activity signs that are predictors of progression, determining, in such cases, an aggressive therapeutic approach. Based on a literature search the authors found the following factors that are predictors of progression: clinically, the diffuse variant of the disease and the fast development of alopecia worsen the prognosis; younger age of onset seems to correlate with a less severe disease course. In trichoscopy, perifollicular scaling and peri and interfollicular erythema are activity markers and probably, predictors of progression in frontal area but they are not observed in the temporal region even in cases of fast evolution.


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Cervantes J, Miteva M. Distinct Trichoscopic Features of the Sideburns in Frontal Fibrosing Alopecia Compared to the Frontotemporal Scalp. Skin Appendage Disorders. 2017: p. 50–54.

Abbas O, Chedraoui A, Ghosn S. Frontal fibrosing alopecia presenting with components of Piccardi-Lassueur-Graham-Little syndrome. Journal of the American Academy of Dermatology. 2007: p. S15-S18.

Donati A, Molina L, Doche I, Valente NS, Romiti R. Facial papules in frontal fibrosing alopecia: evidence of vellus follicle involvement. Arch Dermatol. 2011 Dec: p. 1424-7.

López-Pestaña A, Tuneu A, Lobo C, Ormaechea N, Zubizarreta J, Vildosola S, et al. Facial lesions in frontal fibrosing alopecia (FFA): Clinicopathological features in a series of 12 cases. Journal of the American Academy of Dermatology. 2015: p. e1-987.

Pirmez R DEBALea. It’s not all traction: the pseudo “fringe sign” in frontal fibrosing alopecia. Br J Dermatol. 2015: p. 1336-1338.

Fonda-Pascual P, Rodrigues-Barata AR, Buendía-Castaño D, Moreno-Arrones OM, Saceda-Corralo D, Alegre-Sánchez A, et al. Frontal fibrosing alopecia: clinical and prognostic classification. Journal of the European Academy of Dermatology and Venereology. 2017: p. 1739–1745.

Iorizzo M, Tosti A. Frontal Fibrosing Alopecia: An Update on Pathogenesis, Diagnosis, and Treatment. American Journal of Clinical Dermatology. 2019.

Strazzulla LC,LC, Avila L, Li X, Lo Sicco K, Shapiro J. Prognosis, treatment, and disease outcomes in frontal fibrosing alopecia: A retrospective review of 92 cases. Journal of the American Academy of Dermatology. 2018: p. 203-205.

AlGaadi S, Miteva M, Tosti A. Frontal Fibrosing Alopecia in a Male Presenting with Sideburn Loss. Int J Trichology. 2015 Apr-Jun: p. 72-73.

Martínez-Velasco MA, Vázquez-Herrera NE, Colombina V, Maddy AJ, Asz-Sigall D, Tosti A. Frontal Fibrosing Alopecia Severity Index: A Trichoscopic Visual Scale That Correlates Thickness of Peripilar Casts with Severity of Inflammatory Changes at Pathology. Skin Appendage Disorders. 2018.

Gaspar NK. DHEA and frontal fibrosing alopecia: molecular and physiopathological mechanisms. Anais Brasileiros de Dermatologia. 2016: p. 776–780.

Goodarzi HR,AA,SM,TMB,&NDMR. MicroRNAs take part in pathophysiology and pathogenesis of Male Pattern Baldness. Molecular Biology Reports. 2009: p. 2959–2965.

Tziotzios C. AC,HS,CF,LSM,PI,K,RJ,SC,KN,VGS,PC,FDA,SMA,OA,MJA. Tissue and Circulating MicroRNA Co-expression Analysis Shows Potential Involvement of miRNAs in the Pathobiology of Frontal Fibrosing Alopecia. Journal of Investigative Dermatology. 2017: p. 2440–2443.

Rubegni P, Mandato F, Fimiani M. Frontal Fibrosing Alopecia: Role of Dermoscopy in Differential Diagnosis. Case Reports in Dermatology. 2010: p. 40-45.

Kossard S. Postmenopausal frontal fibrosing alopecia. Scarring alopecia in a pattern distribution. Arch Dermatol. 1994: p. 770–774.

Toledo-Pastrana T, Hernández MJG, Camacho Martínez FM. Perifollicular Erythema as a Trichoscopy Sign of Progression in Frontal Fibrosing Alopecia. International Journal of Trichology. 2013: p. 151–153.

Miteva M, Tosti A. The follicular triad: a pathological clue to the diagnosis of early frontal fibrosing alopecia. British Journal of Dermatology. 2011: p. 440–442.

Samrao A, Chew AL, Price V. Frontal fibrosing alopecia: a clinical review of 36 patients. British Journal of Dermatology. 2010: p. 1296-1300.

Mireles-Rocha H, Sánchez-Dueñas LE, Hernández-Torres M. Alopecia frontal fibrosante. Hallazgos dermatoscópicos. Actas Dermo-Sifiliográficas. 2012: p. 167-168.

Lacarrubba F, Micali G, Tosti A. Scalp Dermoscopy or Trichoscopy. Current Problems in Dermatology. 2015: p. 21-32.

Romiti R, Biancardi Gavioli CF, Anzai A, Munck A, Costa Fechine CO, Valente NYS. Clinical and Histopathological Findings of Frontal Fibrosing Alopecia-Associated Lichen Planus Pigmentosus. Skin Appendage Disorders. 2017: p. 59-63.

Inui S, Nakajima T, Shono F, Itami S. Dermoscopic findings in frontal fibrosing alopecia: report of four cases. International Journal of Dermatology. 2008: p. 796–799.

Pirmez A, Donati A, Valente N, Sodré C, Tosti A. Glabellar red dots in frontal fibrosing alopecia: a further clinical sign of vellus follicle involvement. Br J Dermatol. 2014 Mar: p. 745-6.

How to Cite
Tavares de Figueired, I. o, & Oliveira Soares, R. (2019). Predictive Factors of Progression in Frontal Fibrosing Alopecia. Journal of the Portuguese Society of Dermatology and Venereology, 77(2), 153-156.
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