Women with frontal fibrosing alopecia (FFA) were found to have a higher prevalence of autoimmune disease, thyroid hormone abnormalities, and estrogen deficiency compared with the general population, according to study research published in the British Journal of Dermatology.

The study included phenotypic data from 711 women (median age, 66) living in the United Kingdom and of Eurasian ancestry with a diagnosis of FFA. In this cohort, the median duration of scalp hair loss was 7 years, 73.2% of women had frontotemporal hairline recession following menopause, 77.3% had perifollicular erythema, 26.0% had hyperkeratosis, and 26.0% had concomitant occipital recession. In addition, 90.6% of participants had eyebrow loss and 44.5% had eyelash loss. Furthermore, 77.5% of the cohort had limb hair loss, which most commonly affected the arms and legs, and 67.0% had concomitant axillary/pubic hair loss.

Classic lichen planopilaris (14.7%) and nail changes of any type (23.7%) were also noted in the participants. Other forms of lichen planus were reported in 9.5% of the women, with oral (5.1%) and vulval disease (3.5%) the most common.

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According to the study authors, 44.0% of participants had been prescribed a medication for FFA, with hydroxychloroquine (24.0%) the most frequently prescribed treatment. Other treatments included topical corticosteroids (16.6%), oral tetracycline antibiotics (10.1%), topical calcineurin inhibitors (3.8%), intralesional steroids (1.7%), and oral corticosteroids (1.3%).

A total of 20.7% of participants reported at least 1 comorbid autoimmune disease, with autoimmune thyroid disease (12.9%) the most common, followed by celiac disease (1.5%) and pernicious anemia (1.2%). In addition, 5.6% of women had a history of estrogen deficiency secondary to oophorectomy or primary ovarian insufficiency, and 2.3% reported exposure to selective estrogen receptor modulators (tamoxifen or clomiphene). An oral contraceptive pill was used for more than 6 months by 71.2% of the women.

Study limitations include its cross-sectional design, lack of a control group, and missing data for some clinical features.

“These findings accord with other epidemiological studies and the results of our genetic investigation, which implicated causal genetic variation related to antigen presentation and hormone/xenobiotic metabolism in FFA pathogenesis,” stated the investigators.


McSweeney SM, Christou EAA, Dand N, et al. Frontal fibrosing alopecia: A descriptive cross-sectional study of 711 female cases from the U.K [published online July 11, 2020]. Br J Dermatol. doi: 10.1111/BJD.19399