Clinical Characteristics of Frontal Fibrosing Alopecia in Brazil: A Series of 59 Patients
Introduction: Clinical characteristics of frontal fibrosing alopecia (FFA) have been studied since its description in 1994 in Europe, North America and Australia, and the present study is the largest on FFA features in Latin America.
Methods: This study, through questionnaire and medical records, describes characteristics of a Brazilian population of 59 patients with FFA, concerning clinical forms, individual features and use of cosmetic products.
Results: Mean patients’ age was 58.4 years (range 35-84y). Duration of disease varied from six months to 20y (median 5y). Most women were postmenopausal (83.1%) and non-smokers (83.1%). Five percent had at least one associated autoimmune disease, most commonly hypothyroidism (13.6%). Six of 40 patients (15%) had lichen planus pigmentosus and ten had facial papules (25%). Eyebrow alopecia occurred in 50 (84.7%), and body hair loss in 47 (79.7%). Facial papules were more prevalent in premenopausal women.
Conclusion: Studying FFA epide- miology may help understanding the pathophysiology of this epidemic disease and this study highlights similarities and differences to previously published studies in FFA, such as greater frequency in postmenopausal women, association with hypothyroidism and facial irritation with cosmetic products.
Mirmirani P, Tosti A, Goldberg L, Whiting D, Sotoo- dian B. Frontal fibrosing alopecia: an emerging epi- demic. Skin Appendage Disord. 2019;5:90-3. doi: 10.1159/000489793.
Kossard S. Postmenopausal frontal fibrosing alopecia. Scarring alopecia in a pattern distribution. Arch Derma- tol. 1994;130:770-4.
Vañó-Galván S, Molina-Ruiz AM, Serrano-Falcón C, Arias-Santiago S, Rodrigues-Barata AR, Garnacho- -Saucedo G, et al. Frontal fibrosing alopecia: a mul- ticenter review of 355 patients. J Am Acad Dermatol. 2014;70:670-8. doi: 10.1016/j.jaad.2013.12.003.
Valesky EM, Maier MD, Kippenberger S, Kaufmann R, Meissner M. Frontal fibrosing alopecia - review of recent case reports and case series in PubMed. J Dtsch Derma- tol Ges. 2018;16:992-9. doi: 10.1111/ddg.13601.
Moreno-Arrones OM, Saceda-Corralo D, Rodrigues-Ba- rata AR, Castellanos-González M, Fernández-Pugnaire MA, Grimalt R, et al. Risk factors associated with fron- tal fibrosing alopecia: a multicentre case-control study. Clin Exp Dermatol. 2019;44:404-10. doi: 10.1111/ ced.13785.
Chew AL, Bashir SJ, Wain EM, Fenton DA, Stefanato CM. Expanding the spectrum of frontal fibrosing alopecia: a unifying concept. J Am Acad Dermatol. 2010;63:653- 60.
Iorizzo M, Tosti A. Frontal fibrosing alopecia: an update on pathogenesis, diagnosis, and treatment. Am J Clin Dermatol. 2019;20:379-90. doi: 10.1007/s40257- 019-00424-y.
Tziotzios C, Stefanato CM, Fenton DA, Simpson MA, McGrath JA. Frontal fibrosing alopecia: reflections and hypotheses on aetiology and pathogenesis. Exp Derma- tol. 2016;25:847-52. doi: 10.1111/exd.13071.
To D, Beecker J. Frontal fibrosing alopecia: update and review of challenges and successes. J Cutan Med Surg. 2018;22:182-9. doi: 10.1177/1203475417736279.
Roche M, Walsh M, Armstrong D. Frontal fibrosing alo- pecia - ocurrence in male and female siblings. J Am Acad Dermatol. 2008;58:AB 81.
Tziotzios C, Petridis C, Dand N, Ainali C, Saklatvala JR, Pullabhatla V, et al. Genome-wide association study in frontal fibrosing alopecia identifies four susceptibility loci
including HLA-B*07:02. Nat Commun. 2019;10:1150.
Aldoori N, Dobson K, Holden CR, McDonagh AJ, Har-
ries M, Messenger AG. Frontal fibrosing alopecia: pos- sible association with leave-on facial skin care products and sunscreens; a questionnaire study. Br J Dermatol. 2016;175:762-7. doi: 10.1111/bjd.14535.
Debroy Kidambi A, Dobson K, Holmes S, Carauna D, Del Marmol V, Vujovic A, et al. Frontal fibrosing alo- pecia in men: an association with facial moisturizers and sunscreens. Br J Dermatol. 2017;177:260-1. doi: 10.1111/bjd.15311.
Moreno-Arrones OM, Saceda-Corralo D, Fonda-Pas- cual P, Rodrigues-Barata AR, Buendía-Castaño D, Ale- gre-Sánchez A, et al. Frontal fibrosing alopecia: clinical and prognostic classification. J Eur Acad Dermatol Ve- nereol. 2017;31:1739-45. doi: 10.1111/jdv.14287.
Rossi A, Grassi S, Fortuna MC, Garelli V, Pranteda G, Caro G, et al. Unusual patterns of presentation of frontal fibrosing alopecia: A clinical and trichoscopic analysis of 98 patients. J Am Acad Dermatol. 2017;77:172-4. doi: 10.1016/j.jaad.2017.02.012.
Contin LA, de Almeida Ledá YL, Caldeira Nassif K, Suárez Restrepo MV. Patchy frontal fibrosing alope- cia: description of an incomplete clinical presenta- tion. Skin Appendage Disord. 2017;3:190-2. doi: 10.1159/000475821.
Secchin P, Quintella DC, Paula NO, Andrade LC, Sodré CT. Clinical-histopathological profile of the frontal fi- brosing alopecia: a retrospective study of 16 cases of a university hospital. An Bras Dermatol. 2019;94:416- 21. doi: 10.1590/abd1806-4841.20197797
Mardones F, Shapiro J. Lichen planopilaris in a Latin American (Chilean) population: demographics, clinical profile and treatment experience. Clin Exp Dermatol. 2017;42:755-9. doi: 10.1111/ced.13203.
Imhof RL, Chaudhry HM, Larkin SC, Torgerson RR, Tolkachjov SN. Frontal fibrosing alopecia in women: the Mayo Clinic experience with 148 patients, 1992-2016. Mayo Clin Proc. 2018;93:1581-8. doi: 10.1016/j. mayocp.2018.05.036.
Mervis JS, Borda LJ, Miteva M. Facial and extrafa- cial lesions in an ethnically diverse series of 91 pa- tients with frontal fibrosing alopecia followed at a single center. Dermatology. 2019;235:112-9. doi: 10.1159/000494603.
Kusano LD, Brenner FA. Frontal fibrosing alo- pecia: follow-up of a Brazilian group. An Bras Dermatol. 2019;94:365-6. doi: 10.1590/abd1806- 4841.20197941.
Copyright (c) 2020 Journal of the Portuguese Society of Dermatology and Venereology
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
All articles in this journal are Open Access and meet the requirements of funding bodies or academic institutions. Each article published in the Journal is published under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND 4.0). Articles can be read, downloaded, printed, and shared.
Submission of an article for publication implies the authors’ consent to publication under the applicable Creative Commons license and the terms and conditions of the Publisher’s Licensing Agreement.
It is the author's responsibility to obtain permission to reproduce illustrations, tables, etc. from other publications.
Upon acceptance of an article, authors will be asked to complete a 'Journal Publishing Agreement'. An e-mail will be sent to the corresponding author confirming receipt of the manuscript together with a 'Journal Publishing Agreement' form or a link to the online version of this agreement.
Author rights: As an author you (or your employer or institution) have certain rights to reuse your work.
The Journal reserves the right to use plagiarism detection software on any submitted material.