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Research Letter
April 22, 2020

Association of Inflammation With Progression of Hair Loss in Women With Frontal Fibrosing Alopecia

Author Affiliations
  • 1Servicio de Dermatología, Hospital Universitario Ramón y Cajal, Departamento de Medicina, Facultad de Medicina, Universidad de Alcalá, IRYCIS, Madrid, Spain
  • 2Grupo de Dermatología Pedro Jaén, Madrid, Spain
JAMA Dermatol. Published online April 22, 2020. doi:10.1001/jamadermatol.2020.0359

Frontal fibrosing alopecia (FFA) is a cicatricial alopecia that results in hair follicle destruction on the frontotemporal hairline. To our knowledge, the association of inflammation with progression of the disease has not been studied prospectively.

We conducted this prospective cohort study between January 2016 and June 2019. The study was approved by the institutional review board of Hospital Ramón y Cajal. Verbal informed consent was obtained from each participant. Patient inclusion criteria were an age of 18 years or older and fulfillment of the diagnostic criteria of FFA.1 All patients started treatment with oral dutasteride (0.5 mg 3 times weekly), topical clobetasol (twice weekly), and triamcinolone injections (4-8 mg/mL every 6 months). Every patient was assessed with the Frontal Fibrosing Alopecia Severity Score (FFASS) during every 6-month visit.2 To improve the accuracy of the inflammation score, perifollicular scaling and erythema were evaluated by trichoscopy (grade 2, trichoscopic and clinical inflammatory signs present; grade 1, inflammatory signs not clinically evident, but present in trichoscopy; grade 0, absence of inflammatory signs). We considered that there was no progression of alopecia when there was not any increase in the FFASS extent score and that inflammation was controlled when the mean FFASS inflammation score remained less than 1. Exclusion criteria were changes in the initial treatment, a follow-up for less than 12 months, and coexistence of other hair loss conditions. Descriptive statistics were used to describe the study participants and the FFASS scores. A t test was used to compare continuous variables. A 2-sided P value <.05 was considered statistically significant. Analysis was performed with SPSS statistical software version 15.0 (IBM Corp).

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