Frontal Fibrosing Alopecia: A prospective observational study

Introduction: Frontal fibrosing alopecia (FFA) is a scarring alopecia of unknown etiology that affects mainly postmenopausal women. It is responsible for progressive recession of the frontotemporal hairline and sometimes occipital hairline with inconsistent eyebrow hair loss. We aimed to investigate the demographics, clinical and trichoscopic features of FFA in the Moroccan population. Patients and methods: We conducted a prospective study over a period of 2 years and 1/2, from January 2020 to July 2022. We enrolled twenty four patients, with clinical and/or histopathological diagnosis of FFA, seen at the dermatology department of Ibn Rochd University Hospital in Casablanca, Morocco. Data regarding demographics, clinical and trichoscopic findings were collected. Results: Twenty Four patients with FFA met the inclusion criteria. There were all women and half of them were postmenopausal (50%). The average age of disease onset was 46,95 years old. Pruritus was the most reported symptom (80%). An emotional factor was found in 40% of the cases and 45% of the patients reported the use of traditional products to their hairs. All patients presented with frontotemporal hairline recession with parietal or occipital involvement in 70% and 50% of the cases respectively, and 16 patients experienced eyebrow loss. Facial micropapules were found in 9 patients (45%), followed by patchy hyperpigmentation in 6 patients (30%) and follicular hyperpigmentation in 4 patients (20%). The majority of patients presented mild FFA (grades I and II), with a recession of less than 3 cm of the frontotemporal hairline (85%). The most frequent trichoscopic findings were perifollicular erythema (80%) and follicular hyperkeratosis (70%), followed by decreased or absence of vellus hairs (60%), lonely hairs (45%), perifollicular blue-gray pigmentation (35%), perifollicular brownish pigmentation (30%) and loss or absence of follicular openings (30%). Tufted hairs and white patches of scarring alopecia were found in 25% and 20% patients, respectively. Conclusion: Our study supports the role of cosmetic products or emotional factors in the physiopathology of FFA. Trichoscopy seems a valuable tool in the diagnosis of AFF. Perifollicular erythema, follicular hyperkeratosis and decreased of absence of vellus hairs are easily identified and are very suggestive of the diagnosis.