title: Frontal fibrosing alopecia: a review of 60 cases.
abstract: BACKGROUND
  Frontal fibrosing alopecia (FFA) is a variant of lichen planopilaris primarily affecting postmenopausal women, with a predilection for the frontotemporal hairline.
  
  
  OBJECTIVE
  We sought to examine possible causal associations and review the clinical features, natural history, and response to treatment of patients with FFA attending a specialist hair clinic.
  
  
  METHODS
  This was a case note review of 60 patients with FFA.
  
  
  RESULTS
  The number of patients with FFA seen has increased over the last decade. All were Caucasian women, with significantly above-average affluence scores and were less likely to be smokers. The mean age at presentation was 64 years and average disease duration was 3.4 years (range: 6 months-30 years). Three patients were premenopausal. All patients had frontotemporal involvement, with follicular hyperkeratosis, scarring, and variable perifollicular erythema. Several patients had more unusual patterns: 8 had extensive parietal involvement, 4 had occipital involvement, 1 had asymmetric frontal involvement, and 5 had typical FFA associated with diffuse scalp lichen planopilaris. Eyebrow loss was documented in 73%, eyelash loss in 3%, and body hair loss in 25%. Almost all patients had been treated with superpotent topical steroids. Other treatments included topical calcineurin inhibitors; intralesional triamcinolone acetate; phototherapy; hydroxychloroquine; lymecycline; and prednisolone. Although some treatments may reduce inflammation, their efficacy in controlling the progress of the alopecia was uncertain.
  
  
  CONCLUSIONS
  This is a retrospective review.
  
  
  CONCLUSIONS
  FFA is a clinically distinctive condition, the prevalence of which appears to be increasing. It has a generally poor response to treatment. The origin remains uncertain.
authors.affiliation: Alan Lyell Center for Dermatology, Southern General Hospital, Glasgow, United Kingdom. alisonmacdonald21@doctors.org.uk
authors.forename: Alison
authors.initials: A
authors.lastname: MacDonald
authors.forename: Colin
authors.initials: C
authors.lastname: Clark
authors.forename: Susan
authors.initials: S
authors.lastname: Holmes
mesh_terms: D000328:Adult; D000368:Aged; D000505:Alopecia / Q000175:diagnosis / Q000276:immunology / Q000473:pathology*; D015551:Autoimmunity; D065095:Calcineurin Inhibitors; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D014221:Triamcinolone / Q000008:administration & dosage
chemical_list: D065095:Calcineurin Inhibitors; D005938:Glucocorticoids; D014221:Triamcinolone