Frontal fibrosing alopecia in Asians: a retrospective clinical study

Frontal fibrosing alopecia (FFA) is a distinctive form of primary lymphocytic cicatricial alopecia and predominantly occurs in postmenopausal women. The condition is increasing in prevalence worldwide. However, there is a paucity of information regarding FFA in Asians because of a lack of published literature. We aimed to describe the demographics, clinical and trichoscopic features, and treatment outcomes of FFA in Asian patients.

We conducted a retrospective clinical study including patients diagnosed with FFA. Data regarding demographics, clinical and trichoscopic findings, and treatment outcomes were collected. The data were analyzed using descriptive statistics.

Fifty-six Thai patients with FFA met the inclusion criteria. There were 54 females (96.4%) and two males (3.6%), and the average age of disease onset was 51.3 ± 6.3 years. All patients presented with frontotemporal hairline recession, and 49 patients (87.5%) experienced eyebrow loss. Trichoscopy in 35 patients revealed follicular dropout, perifollicular erythema, and lonely hair in 35 (100%), 29 (82.8%) and 26 patients (74.2%), respectively. Disease stabilization was superiorly observed in patients treated with a combination of topical corticosteroids and hydroxychloroquine or finasteride (79.3% and 73.3%, respectively).

Our study presents the largest series of FFA in Asians and reports mixed clinical patterns between Caucasian and African patients. Combination therapy of topical corticosteroids and hydroxychloroquine or the use of topical corticosteroids and finasteride may halt the progression of FFA in Asians.