Martínez-Velasco María Abril, Vázquez-Herrera Norma Elizabeth, Misciali Cosimo, Vincenzi Colombina, Maddy Austin John, Asz-Sigall Daniel, Tosti Antonella
Clínica de Oncodermatología, Universidad Nacional Autónoma de México, Ciudad de México, Mexico.
Tecnologico de Monterrey, Monterrey, Mexico.
Skin Appendage Disord. 2018 Oct;4(4):277-280. doi: 10.1159/000487158. Epub 2018 Mar 2.
Frontal fibrosing alopecia (FFA) is a scarring alopecia that mainly affects postmenopausal women characterized by recession of the frontotemporal hairline and eyebrow loss. Current techniques to assess FFA activity are limited and involve noninvasive tools that assess disease progression or an invasive technique such as scalp biopsies. However, since progression of FFA is very slow, it is very important to develop a noninvasive technique to assess disease activity to monitor treatment response.
To provide a standardized and objective method to assess FFA activity.
We evaluated the correlation between trichoscopy and pathological features (degree of lymphocytic infiltration) in 20 dermoscopy-guided biopsies of FFA. At trichoscopy, we divided the severity of peripilar casts into 3 grades according to their thickness. To validate the trichoscopic visual scale, we showed the images to 7 dermatologists with interest in hair diseases. Concordance was assessed using the Kendall Tau-b concordance test.
A strong correlation between severity of peripilar casts at trichoscopy and degree of lymphocytic infiltrate was observed by the Kendall Tau-b test. Validation showed very good inter- and intraobserver agreement.
The trichoscopic visual scale allows noninvasive assessment of scalp inflammation in FFA in different scalp regions and therefore provides optimal guidance for treatment.
额部纤维性脱发（FFA）是一种瘢痕性脱发，主要影响绝经后女性，其特征为额颞部发际线后移和眉毛脱落。目前评估FFA活动的技术有限，包括评估疾病进展的非侵入性工具或头皮活检等侵入性技术。然而，由于FFA进展非常缓慢，开发一种非侵入性技术来评估疾病活动以监测治疗反应非常重要。
提供一种标准化、客观的方法来评估FFA活动。
我们评估了20例FFA皮肤镜引导下活检中毛发镜检查结果与病理特征（淋巴细胞浸润程度）之间的相关性。在毛发镜检查中，我们根据毛囊周围铸型的厚度将其严重程度分为3级。为验证毛发镜视觉评分标准，我们将图像展示给7位对毛发疾病感兴趣的皮肤科医生。使用肯德尔Tau-b一致性检验评估一致性。
通过肯德尔Tau-b检验观察到毛发镜检查中毛囊周围铸型的严重程度与淋巴细胞浸润程度之间存在强相关性。验证显示观察者间和观察者内一致性非常好。
毛发镜视觉评分标准允许对不同头皮区域的FFA头皮炎症进行非侵入性评估，因此为治疗提供了最佳指导。
