Frontal fibrosing alopecia: a clinical review of 36 patients.
BACKGROUND
Frontal fibrosing alopecia (FFA) is a primary lymphocytic cicatricial alopecia with a distinctive clinical pattern of progressive frontotemporal hairline recession. Currently, there are no evidence-based studies to guide treatment for patients with FFA; thus, treatment options vary among clinicians.


OBJECTIVE
We report clinical findings and treatment outcomes of 36 patients with FFA, the largest cohort to date. Further, we report the first evidence-based study of the efficacy of hydroxychloroquine in FFA using a quantitative clinical score, the Lichen Planopilaris Activity Index (LPPAI).


METHODS
A retrospective case note review was performed of 36 adult patients with FFA. Data were collected on demographics and clinical findings. Treatment responses to hydroxychloroquine, doxycycline and mycophenolate mofetil were assessed using the LPPAI. Adverse events were monitored.


RESULTS
Most patients in our cohort were female (97%), white (92%) and postmenopausal (83%). Apart from hairline recession, 75% also reported eyebrow loss. Scalp pruritus (67%) and perifollicular erythema (86%) were the most common presenting symptom and sign, respectively. A statistically significant reduction in signs and symptoms in subjects treated with hydroxychloroquine (P < 0·05) was found at both 6- and 12-month follow up.


CONCLUSIONS
In FFA, hairline recession, scalp pruritus, perifollicular erythema and eyebrow loss are common at presentation. Despite the limitations of a retrospective review, our data reveal that hydroxychloroquine is significantly effective in reducing signs and symptoms of FFA after both 6 and 12 months of treatment. However, the lack of a significant reduction in signs and symptoms between 6 and 12 months indicates that the maximal benefits of hydroxychloroquine are evident within the first 6 months of use.
Samrao
A
A
Department of Dermatology, University of California San Francisco, San Francisco, CA 94115, USA.
Chew
A-L
AL
Price
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V
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000505:Alopecia / Q000188:drug therapy / Q000473:pathology; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D015331:Cohort Studies; D003879:Dermatologic Agents / Q000627:therapeutic use*; D004318:Doxycycline / Q000627:therapeutic use; D004791:Enzyme Inhibitors / Q000627:therapeutic use*; D004890:Erythema; D005138:Eyebrows / Q000473:pathology; D005260:Female; D006801:Humans; D006886:Hydroxychloroquine / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000031:analogs & derivatives / Q000627:therapeutic use; D011537:Pruritus / Q000473:pathology; D012189:Retrospective Studies; D012535:Scalp / Q000473:pathology; D012720:Severity of Illness Index; D013997:Time Factors
D000900:Anti-Bacterial Agents; D003879:Dermatologic Agents; D004791:Enzyme Inhibitors; D006886:Hydroxychloroquine; D009173:Mycophenolic Acid; D004318:Doxycycline