Vitamin D Deficiency and Frontal Fibrosing Alopecia

Patients with frontal fibrosing alopecia (FFA) do not need to have vitamin D levels tested as deficiency is unlikely tied to the pathogenesis of FFA.

It is improbable that vitamin D deficiency is associated with the development of frontal fibrosing alopecia (FFA), according to study findings published recently in the Journal of The American Academy of Dermatology International.

The pathogenesis of FFA, characterized by a receding frontal hair line, includes genetic, environmental, and hormonal aspects, and possibly use of facial sunscreen. Lichen planopilaris significantly increases the odds of severe vitamin D deficiency in patients, and FFA is a subclassification of lichen planopilaris with a bias tendency to affect postmenopausal women whose greater risk of low bone mineral density would benefit from vitamin D supplements. Researchers sought to investigate baseline vitamin D levels in a cohort of patients with FFA.

To accomplish this, researchers conducted a retrospective study from March 2013 to February 2020 comparing baseline vitamin D levels in 100 women (mean age, 63 years; 97% White, 2% Asian; 63% with 1 or more comorbidities) with FFA with vitamin D levels in 100 women (mean age, 51 years; 83% White, 16% Asian; 52% with 1 or more comorbidities) with female pattern hair loss (FPHL). Exclusions included patients taking vitamin D supplementation; 99% of the 200 women in the study were nonsmokers. Below 50ng/mL represents vitamin D insufficiency according to Australian therapeutic guidelines, characterized as mild (30-49nmol/L), moderate (12.5-29nmol/L), and severe (<12.5nmol/L).

The mean 25-hydroxy vitamin D level in women with FFA was 68.9nmol/L±21.44nmol/L vs 65.96nmol/L±23.02nmol/L in women with FPHL. Both cohorts recorded 20% of patients with vitamin D insufficiency, and no one with severe insufficiency. Examined by age brackets, vitamin D levels for those under 50 years of age (FFA 65.38nmol/L vs FPHL 63.90nmol/L), 50 to 59 years of age (FFA 56.16 vs FPHL 57.20), and those older than 60 years of age [RS1] (FFA 74.47 vs FPHL 75.83), with no statistical significance in vitamin D levels between the 2 cohorts or across age groups.

Study limitations include being retrospective in nature, the small size, and the preponderance of women participants.

Previous studies have shown patients with nonscarring alopecia to have lower vitamin D levels than control participants, therefore, researchers concluded that there may be no more additional need for patients with FFA to have vitamin D levels measured than for patients with other forms of alopecia. Researchers said, “Vitamin D deficiency is unlikely to be implicated in the pathogenesis of FFA. This finding neither supports nor disproves an association between the application of facial sunscreen and FFA.”

Disclosure: Several study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.


Arasu A, Meah N, Eisman S, Wall D, Sinclair R. Vitamin D status in patients with frontal fibrosing alopecia: A retrospective study. JAAD Int. Published online April 18, 2022. doi:10.1016/j.jdin.2022.03.008