Clinical-histopathological profile of the frontal fibrosing alopecia: a retrospective study of 16 cases of a university hospital

BACKGROUND: Frontal fibrosing alopecia is a condition of unknown origin, histologically similar to classic lichen planopilaris and generally observed in postmenopausal women with alopecia of the frontal-temporal hairline. OBJECTIVES: To describe the clinical, dermatoscopic, and histopathological characteristics and the treatment used in patients who have frontal fibrosing alopecia at the Alopecia Outpatient Clinic in a university hospital. METHODS: Retrospective descriptive study performed by reviewing medical charts and biopsies of the scalp. RESULTS: Sixteen patients were analyzed, all of them female, 93.75% of them postmenopausal, and 56.25% brown-skinned. All had frontal alopecia (100%), followed by temporal alopecia (87.5%) and madarosis (87.5%). On dermatoscopy, perifollicular erythema and tubular scales were found as a sign of disease activity. Of the patients, 68.75% had associated autoimmune diseases, including lupus, thyroid disease and vitiligo. Of the 13 biopsies from 8 patients, 10 showed microscopic aspects compatible with frontal fibrosing alopecia. Laboratory tests did not show major abnormalities and minoxidil was the most used treatment. STUDY LIMITATION: Data collection limited by the study’s retrospective design associated to flaws while filling in the medical charts and absence in standards to the collection and processing of the pathology and histopathological examination. CONCLUSIONS: A demographical, clinical, and histopathological description of 16 patients diagnosed with frontal fibrosing alopecia, which remains a challenging disease, of unknown origin, and frequently associated with autoimmune diseases. This study reinforces literary findings. However, more research is needed to establish the pathogenesis and effective treatments.