title: Frontal fibrosing alopecia: a survey in 16 patients.
abstract: BACKGROUND
  Postmenopausal frontal fibrosing alopecia (PFFA) was described by Kossard et al. as a progressive recession of the frontal hairline affecting particularly postmenopausal women. Further cases of PFFA have been reported to date, all of them considering it as a variant of lichen planopilaris on the basis of its clinical, histological and immunohistochemical features.
  
  
  OBJECTIVE
  To describe clinical features, and response to treatment of 16 cases of frontal fibrosing alopecia diagnosed at our department in the last 6 years.
  
  
  METHODS
  In addition to clinical data, biopsies and laboratory tests (antinuclear antibodies, sex hormones, thyroid hormones) were performed in order to rule out other causes of scarring alopecia. Patients were treated with intralesional corticosteroids, finasteride, and minoxidil, depending on the stage of the disease and association to androgenetic alopecia.
  
  
  RESULTS
  All patients presented progressive alopecia localized to the frontal and temporal hairlines. Eight patients (50%) had loss of eyebrows, and six patients (37.5%) had axillar alopecia. Ages ranged from 45 to 79. Three of these women were premenopausal. Androgenetic alopecia was evident in seven patients (43.8%). All patients biopsied showed perifollicular lymphocitic infiltrate with lamelar fibrosis limited to the upper portions of the follicle. The progression of the condition stopped in most patients after a variable period on treatment. When treatment was abandoned the alopecia progressed to 'clown alopecia' appearance.
  
  
  CONCLUSIONS
  Cases of Kossard's type scarring alopecia affecting premenopausal women made us consider that this condition is not exclusive of postmenopausal women. Differential diagnosis should take into account conditions like female androgenetic alopecia, fibrosing alopecia in a pattern distribution, alopecia areata, and chronic lupus erythematosus. Except for the pattern of alopecia, lichen planopilaris and frontal fibrosing alopecia are indistinguishable, thus the latter is included as a variant of lichen planopilaris. Although the disease tends to spontaneous stabilization, intralesional and topical corticosteroids, and anti-androgens may stop the progression of the disease and improve the female androgenetic alopecia that usually is associated to FFA.
authors.affiliation: Department of Dermatology, University Hospital Virgen Macarena, Seville, Spain. dmoreno@e-derma.org
authors.forename: D
authors.initials: D
authors.lastname: Moreno-Ramírez
authors.forename: F
authors.initials: F
authors.lastname: Camacho Martínez
mesh_terms: D000368:Aged; D000505:Alopecia / Q000175:diagnosis* / Q000188:drug therapy* / Q000473:pathology; D003937:Diagnosis, Differential; D018450:Disease Progression; D004791:Enzyme Inhibitors / Q000627:therapeutic use; D005138:Eyebrows / Q000473:pathology; D005260:Female; D005355:Fibrosis; D018120:Finasteride / Q000627:therapeutic use; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D008875:Middle Aged; D008914:Minoxidil / Q000627:therapeutic use; D017698:Postmenopause; D012536:Scalp Dermatoses / Q000175:diagnosis* / Q000188:drug therapy* / Q000473:pathology; D016896:Treatment Outcome
chemical_list: D004791:Enzyme Inhibitors; D005938:Glucocorticoids; D018120:Finasteride; D008914:Minoxidil