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Notable Notes
November 2017

Frontal Fibrosing Alopecia—The Fashion of the Renaissance

Author Affiliations
  • 1Department of Pathophysiology and Transplantation, Università degli Studi di Milano, IRCCS Foundation, Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
JAMA Dermatol. 2017;153(11):1105. doi:10.1001/jamadermatol.2017.3751

When a dermatologist looks at the painting, Girl With a Pearl Earring (circa 1665), a masterpiece by the Dutch painter Johannes Vermeer, he or she will not remain only impressed by the beauty of the girl or by the reflections of the pearl. They will note that this girl seems to be affected by a dermatologic disease, frontal fibrosing alopecia (FFA). The mysterious girl wears a headscarf to hide her hair; furthermore, she does not have eyebrows. Vermeer was one of the most important painter of the seventeenth century; he specialized in portraits and interiors of the Dutch middle class. Among his other works, The Milkmaid (circa 1657-1658) shows a domestic kitchen maid in a plain room, pouring milk into a container. She wears a blue apron and a linen cap that partially hides her hair. A more careful look reveals that this woman also does not have eyebrows. This is not a coincidence, because according to the fashion during the end of the Middle Ages and Renaissance, women plucked their frontotemporal hairs and eyebrows to create a high, hairless forehead, which was considered to be beautiful. In Italy, this was an ancient fashion and involved the upper classes: the most famous example is the Portrait of Battista Sforza (circa 1465-1472), Duchess of Urbino and wife of Federico da Montefeltro, depicted by Piero della Francesca. This fashion can be regarded as traction alopecia or trichotillomania, whereas FFA is a slowly progressive disease affecting postmenopausal women and is characterized by regression of the frontotemporal hairline and loss of eyebrows.1 The fashion in eyebrow appearance has changed over the centuries, and now eyebrow tattoos can help patients with hair loss due to any cause.2 Dermatologists should be aware of the new fashion of pubic hair grooming; pulling or waxing of pubic hair is associated with risk of sexually transmitted diseases.3

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