Dermatology, Department of Specialized, Diagnostic and Experimental Medicine, University of Bologna, Bologna, Italy.
J Eur Acad Dermatol Venereol. 2019 Feb;33(2):433-438. doi: 10.1111/jdv.15372. Epub 2018 Dec 13.
Frontal fibrosing alopecia (FFA) is increasing in prevalence worldwide and several series from different countries have been published, in order to detect possible causes of the disease outbreak.
To analyze the epidemiological, clinical and trichoscopic features of FFA seen in an Italian Dermatology Unit.
Clinical, trichoscopy, histopathology and medical details of all patients were compared with literature and general population data.
From 2005 to 2017, we diagnosed FFA in 65 Caucasian females, with the number of diagnoses per year progressively rising. Premenopausal onset was detected in 21%. Frontal hair line recession was associated with parietal involvement in 80% of cases, occipital in 12.3% and eyebrows alopecia in 86.1%. In six cases, eyebrow alopecia preceded hair loss. Non-inflammatory facial papules were detected in 1/3 of the patients. Itching was reported by 2/3 of the patients and was indicative of disease progression. Trichoscopy showed empty follicles/yellow dots, absence of follicular ostia, mild follicular hyperkeratosis, perifollicular erythema and 'lonely hair'. Scalp lichen plano-pilaris was seen in 15 patients, female pattern hair loss in 22. Therapy included short-term treatment with systemic or intralesional corticosteroids followed by therapy with 5α-reductase inhibitors of hydroxychloroquine and topical drugs. Arrest of FFA progression was seen in 75% of the patients, while 16 experienced worsening of the hairline despite therapy.
Frontal fibrosing alopecia not rarely starts before menopause, loss of the eyebrows can be the first sign of the disease, about 50% of the patients have other autoimmune conditions, FFA severity is not related to its duration, itching, follicular hyperkeratosis and erythema at trichoscopy are signs of disease progression, 25% of the patients show progression of hairline recession despite therapy.
额部纤维性脱发（FFA）在全球的患病率正在上升，许多来自不同国家的系列研究已发表，以发现该疾病爆发的可能原因。
分析意大利皮肤科就诊的 FFA 的流行病学、临床和毛发镜特征。
比较所有患者的临床、毛发镜、组织病理学和医学详细信息与文献和一般人群数据。
2005 年至 2017 年，我们诊断了 65 例白种女性 FFA，每年的诊断数量呈递增趋势。发现 21%的患者发病于绝经前。80%的病例存在额部发际后退伴顶区受累，12.3%伴枕部受累，86.1%伴眉毛脱落。6 例患者中，眉毛脱落先于脱发。1/3 的患者存在非炎症性面部丘疹。2/3 的患者诉瘙痒，这提示疾病进展。毛发镜显示空毛囊/黄点、毛囊口缺失、轻度毛囊角化过度、毛囊周围红斑和“孤独毛发”。15 例患者存在头皮扁平苔藓样毛发角化病，22 例存在女性型脱发。治疗包括短期全身或皮损内皮质类固醇治疗，随后采用 5α-还原酶抑制剂、羟氯喹和局部药物治疗。75%的患者 FFA 进展得到控制，而 16 例患者尽管接受治疗仍出现发际线恶化。
FFA 并不罕见地在绝经前开始，眉毛脱落可能是疾病的首发表现，约 50%的患者存在其他自身免疫性疾病，FFA 的严重程度与其持续时间无关，瘙痒、毛囊角化过度和毛发镜下红斑是疾病进展的标志，25%的患者尽管接受治疗仍出现发际线后退进展。
