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- Presentation
Pathogenesis: Present, Past and Future of Frontal Fibrosing Alopecia
Description
The presentation discusses the pathogenesis of frontal fibrosing alopecia (FFA), highlighting its classification as a potential variant of lichen planopilaris (LPP) and recent developments in disease coding expected to take effect in October 2024. The speaker emphasizes the importance of recognizing various clinical features in patients with FFA, including hair loss patterns, facial papules, and vascular changes. A brief history of the disease is outlined, noting its emergence in the early 2010s and identifying possible hormonal influences, particularly in postmenopausal women, alongside environmental factors. Studies indicate that anti-androgen therapies have effectively stabilized or improved conditions in some patients. Genetic research has identified susceptibility genes, while environmental factors, particularly related to skin care products, are also being investigated. Emerging insights into the role of neurogenic inflammation, dioxins, and hormonal pathways in FFA contribute to understanding the disorder's complexities. The presentation concludes with an invitation for further exploration at an upcoming world congress, underscoring the ongoing need for research to decode the disease's etiology and improve patient care.
View moreConclusions
- Frontal fibrosing alopecia (FFA) may be a variant of lichen planopilaris (LPP) and both share histological features.
- Distinct ICD-10 codes for FFA and CCCA have been approved and will be effective from October 2024, aiding in clinical and research applications.
- FFA primarily affects postmenopausal women but is increasingly being reported in younger women and men.
- Clinical features of FFA include progressive frontotemporal hair loss, eyebrow loss, and distinctive facial papules with potential involvement of skin-colored papules on the face.
- Diagnosis is generally made based on clinical observations and trichoscopy, rather than reliance on biopsy.
- Hormonal and environmental factors are considered significant in the pathogenesis of FFA, with potential links to cholesterol metabolism.
- The use of 5-alpha reductase inhibitors showed moderate improvement in patients treated with anti-androgens for FFA.
- Research indicates that underlying genetic predispositions may influence susceptibility to FFA.
- Environmental elements, particularly ingredients in facial skincare products and sunscreens, may exacerbate FFA.
- Neurogenic inflammation and the presence of neuropeptides might contribute to the pathology of FFA.
- Allergic contact dermatitis may play a role in exacerbating hair loss in FFA patients, prompting consideration in clinical management.
- The aryl hydrocarbon receptor (AhR) in skin may interact with dioxin-like substances, suggesting environmental factors in the disease's etiology.
- Hordinsky M. LPP & FFA Review Article. JID Innovations, 2022 May; 2(3): 100113. PMCID: PMC9062486. doi: 10.1016/j.xjidi.2022.100113.
- Senna MM, Peterson E, Jozic I, Chéret J, Paus R. Frontiers in Lichen Planopilaris and Frontal Fibrosing Alopecia Research: Pathobiology Progress and Translational Horizons. JID Innov. 2022;2(3):100113. Published online 2022 Mar 1. doi:10.1016/j.xjidi.2022.100113.
- Gonzalez A, Doche I. Overexpression of the aryl hydrocarbon receptor in frontal fibrosing alopecia and lichen planopilaris: a potential pathogenic role for dioxins: an investigational study of 38 patients. JEADV. 2020. doi:10.1111/jdv.16262.
- Aldoori N, Dobson K, Holden CR, McDonagh AJ, Harries M, Messenger AG. Frontal fibrosing alopecia: possible association with leave-on facial skin care products and sunscreens; a questionnaire study. British Journal of Dermatology. doi:10.1111/bjd.18410.