title: Frontal fibrosing alopecia: possible association with leave-on facial skin care products and sunscreens; a questionnaire study.
abstract: BACKGROUND
  Since its first description in 1994, frontal fibrosing alopecia (FFA) has become increasingly common, suggesting that environmental factors are involved in the aetiology.
  
  
  OBJECTIVE
  To identify possible causative environmental factors in FFA.
  
  
  METHODS
  A questionnaire enquiring about exposure to a wide range of lifestyle, social and medical factors was completed by 105 women with FFA and 100 age- and sex-matched control subjects. A subcohort of women with FFA was patch tested to an extended British standard series of allergens.
  
  
  RESULTS
  The use of sunscreens was significantly greater in the FFA group compared with controls. Subjects with FFA also showed a trend towards more frequent use of facial moisturizers and foundations but, compared with controls, the difference in frequencies just failed to reach statistical significance. The frequency of hair shampooing, oral contraceptive use, hair colouring and facial hair removal were significantly lower in the FFA group than in controls. Thyroid disease was more common in subjects with FFA than controls and there was a high frequency of positive patch tests in women with FFA, mainly to fragrances.
  
  
  CONCLUSIONS
  Our findings suggest an association between FFA and the use of facial skin care products. The high frequency of sunscreen use in patients with FFA, and the fact that many facial skin care products now contain sunscreens, raises the possibility of a causative role for sunscreen chemicals. The high frequency of positive patch tests in women with FFA and the association with thyroid disease may indicate a predisposition to immune-mediated disease.
authors.affiliation: Department of Dermatology, Royal Hallamshire Hospital, Sheffield, S10 2JF, U.K.
authors.forename: N
authors.initials: N
authors.lastname: Aldoori
authors.affiliation: Department of Dermatology, Royal Hallamshire Hospital, Sheffield, S10 2JF, U.K.
authors.forename: K
authors.initials: K
authors.lastname: Dobson
authors.affiliation: Department of Dermatology, Royal Hallamshire Hospital, Sheffield, S10 2JF, U.K.
authors.forename: C R
authors.initials: CR
authors.lastname: Holden
authors.affiliation: Department of Dermatology, Royal Hallamshire Hospital, Sheffield, S10 2JF, U.K.
authors.forename: A J
authors.initials: AJ
authors.lastname: McDonagh
authors.affiliation: The Dermatology Centre, Manchester University, Salford Royal NHS Foundation Trust, Salford, M6 8HD, U.K.
authors.forename: M
authors.initials: M
authors.lastname: Harries
authors.affiliation: Department of Dermatology, Royal Hallamshire Hospital, Sheffield, S10 2JF, U.K.. a.g.messenger@sheffield.ac.uk.
authors.forename: A G
authors.initials: AG
authors.lastname: Messenger
mesh_terms: D000328:Adult; D000368:Aged; D000505:Alopecia / Q000139:chemically induced*; D003358:Cosmetics / Q000009:adverse effects; D003879:Dermatologic Agents / Q000009:adverse effects*; D005260:Female; D006203:Hair Preparations / Q000009:adverse effects; D006801:Humans; D008019:Life Style; D016555:Matched-Pair Analysis; D008875:Middle Aged; D010328:Patch Tests; D010476:Perfume / Q000009:adverse effects; D017592:Skin Care / Q000009:adverse effects*; D013473:Sunscreening Agents / Q000009:adverse effects; D011795:Surveys and Questionnaires
chemical_list: D003358:Cosmetics; D003879:Dermatologic Agents; D006203:Hair Preparations; D010476:Perfume; D013473:Sunscreening Agents