Frontal Fibrosing Alopecia: An Update on Epidemiology and Treatment.

Downloaded from ClinicalKey.com at Inova Fairfax Hospi For personal use only. No other uses without permission. Copyright ©2 any questions on etiology and treatment remain unanwered. We would like to draw attention to the largest series f patients to date, which was recently reported by Vañó t al.,1 who compiled 355 cases with striking results, such s an increased incidence of early menopause (14% vs 6% in he general population), suggesting that low estrogen levls can play a key role in the etiology of the disease. Also oteworthy is the presence of androgenic alopecia in 40% of atients, which was much greater than in other series,2 and f hypothyroidism in 15% (4.2% in the general population), hich also points to a possible hormonal etiology. Findings uch as diffuse reduction in body hair (present in 24%), eyeash loss (14%), and perifollicular papules on the face (14%) re associated with a poorer prognosis and may indicate the eed for systemic treatment. However, eyebrow loss as the rst manifestation of FFA seems to be associated with milder orms. The modest findings to date on the treatment of FA are based on meager and poor quality scientific vidence. In the study by Vañó et al.,1 the most effecive drugs were the 5-alfa-reductase inhibitors finasteride nd dutasteride----perhaps because of the high prevaence of female androgenetic alopecia in this series----and ntralesional corticosteroids. These data are similar to hose reported in a systematic review.3 Therefore, 5-alfaeductase inhibitors could prove useful as maintenance herapy: they lead to improvement in 45% of patients and tabilization in 53%.1 Furthermore, they could be used in