The chronic use of topical corticosteroids (TCs) among patients with frontal fibrosing alopecia (FFA) increases the presence of arborizing vessels and vessel nets in these individuals, which can hinder the assessment of inflammation, according to the results of a retrospective analysis of trichoscopic images and medical records published in the Journal of the American Academy of Dermatology.

The investigators sought to identify steroid-induced changes on trichoscopy in patients with FFA. Among those in the retrospective analysis, some did not receive TC treatment for alopecia, whereas others used TCs chronically (ie, ≥6 months every other day).

A total of 33 lesions from 19 patients with FFA were recovered. Of the 19 participants, 8 had never used a TC and 11 individuals were referred for chronic use of TCs.

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Trichoscopic features among chronic TC users vs those who did not use TCs included perifollicular erythema (24% vs 75%, respectively; P =.009), perifollicular brown discoloration (19% vs 67%, respectively; P =.01), peripilar casts (52% vs 92%, respectively; P >.05), and white patches (95% vs 100%, respectively; P >.05). Pili torti were identified in 12 lesions (71% vs 25%, respectively; P =.03), and interfollicular scaling in 6 lesions (10% vs 25%, respectively; P >.05).

Vascular structures were detected more frequently among chronic TC users vs nonusers, including thin arborizing vessels (95% vs 42%, respectively; P <.001) and thick arborizing vessels and extravasated hemorrhages (24% vs 0%, respectively; P >.05).

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In addition, diffuse erythema was revealed in 19 lesions (67% vs 33%, respectively; P >.05). Notably, the chronic use of TCs was associated with an absence of perifollicular erythema and enhanced the interfollicular vascular structures. This pattern, which was called the “interfollicular vessel net,” was detected in 21% of the lesions (33% vs 0%, respectively; P <.03).

The investigators concluded that the changes reported among patients with FFA who use TCs chronically may hinder the evaluation of inflammation in this population. 


Saceda-Corralo D, Moreno-Arrones OM, Fonda-Pascual P, et al. Steroid-induced changes noted on trichoscopy of patients with frontal fibrosing alopecia [published online May 4, 2018]. J Am Acad Dermatol. doi: 10.1016/j.jaad.2018.05.001