Frontal fibrosing alopecia: a multicenter review of 355 patients

J Am Acad Dermatol. 2014 Apr;70(4):670-678. doi: 10.1016/j.jaad.2013.12.003. Epub 2014 Feb 5.


Background: To our knowledge, there are no large multicenter studies concerning frontal fibrosing alopecia (FFA) that could give clues about its pathogenesis and best treatment.

Objective: We sought to describe the epidemiology, comorbidities, clinical presentation, diagnostic findings, and therapeutic choices in a large series of patients with FFA.

Methods: This retrospective multicenter study included patients given the diagnosis of FFA. Clinical severity was classified based on the recession of the frontotemporal hairline.

Results: In all, 355 patients (343 women [49 premenopausal] and 12 men) with a mean age of 61 years (range 23-86) were included. Early menopause was detected in 49 patients (14%), whereas 46 (13%) had undergone hysterectomy. Severe FFA was observed in 131 patients (37%). Independent factors associated with severe FFA after multivariate analysis were: eyelash loss, facial papules, and body hair involvement. Eyebrow loss as the initial clinical presentation was associated with mild forms. Antiandrogens such as finasteride and dutasteride were used in 111 patients (31%), with improvement in 52 (47%) and stabilization in 59 (53%).

Limitations: The retrospective design is a limitation.

Conclusions: Eyelash loss, facial papules, and body hair involvement were associated with severe FFA. Antiandrogens were the most useful treatment.

Keywords: alopecia; dutasteride; finasteride; frontal fibrosing alopecia; hair; hair loss; lichen planopilaris; scarring; trichology.

Publication types

  • Comparative Study
  • Multicenter Study

MeSH terms

  • Adult
  • Age Distribution
  • Aged
  • Aged, 80 and over
  • Alopecia / drug therapy*
  • Alopecia / epidemiology
  • Alopecia / pathology*
  • Azasteroids / therapeutic use*
  • Biopsy, Needle
  • Cohort Studies
  • Dutasteride
  • Female
  • Fibrosis / epidemiology
  • Fibrosis / pathology
  • Finasteride / therapeutic use*
  • Forehead
  • Humans
  • Immunohistochemistry
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Postmenopause / physiology
  • Retrospective Studies
  • Risk Assessment
  • Severity of Illness Index
  • Sex Distribution
  • Spain / epidemiology
  • Treatment Outcome
  • Young Adult


  • Azasteroids
  • Finasteride
  • Dutasteride