Abstract：
BACKGROUND: Frontal fibrosing alopecia (FFA) is a cicatricial alopecia affecting the frontotemporal hairline. Given that this scarring, immune-mediated follicular destruction most commonly affects postmenopausal Caucasian women, researchers have postulated that there are hormonal and genetic components; however, the etiology of FFA is still unknown. Recently, dermatologists have reported cases of FFA as being potentially caused by cosmetic products, such as sunscreen and shampoo. Therefore, this systematic review and meta-analysis intend to be the first to analyze the relationship between FFA and cosmetic/personal care products and treatments, including sunscreen, moisturizer, foundation, shampoo, conditioner, hair mousse, hair gel, hair dye, hair straightening/rebonding, chemical/laser facial resurfacing, aftershave, and facial cleanser.
METHODS: The Cochrane, PubMed, EMBASE, and Medline (Ovid) databases were searched for the relevant studies from the date of inception to August 2022. Case-control, cross-sectional, and cohort studies examining the effects of cosmetic/personal care product use on FFA, available in English full-text, were included. Analyses were performed using Review Manager, version 5.4. Results were reported as an odds ratio (OR) with a 95% confidence interval (CI); p values < 0.05 were considered significant.
RESULTS: Nine studies were included in our quantitative analyses, totaling 1,248 FFA patients and 1,459 controls. There were significant positive associations found for FFA and sunscreen (OR 3.02, 95% CI 1.67-5.47; p = 0.0003) and facial moisturizer (OR 2.20, 95% CI 1.51-3.20; p < 0.0001) use. Gender sub-analyses demonstrated a positive association for FFA and facial moisturizer in men (OR 5.07, 95% CI 1.40-18.32; p = 0.01), but not in women (OR 1.58, 95% CI 0.83-2.98; p = 0.16). Both gender sub-analyses were significantly positive for the association with facial sunscreen (Male OR 4.61, 95% CI 1.54-13.78, p = 0.006; Female OR 2.74, 95% CI 1.32-5.70, p = 0.007). There was no association found for a facial cleanser (OR 1.14, 95% CI 0.33-1.52; p = 0.51), foundation (OR 1.13, 95% CI 0.83-1.55; p = 0.21), shampoo (OR 0.49, 95% CI 0.22-1.10; p = 0.08), hair conditioner (OR 0.81, 95% CI 0.52-1.26; p = 0.35), hair mousse (OR 1.37, 95% CI 0.75-2.51; p = 0.31), and hair gel (OR 0.90, 95% CI 0.48-1.69; p = 0.74), hair dye (OR 1.07, 95% CI 0.69-1.64; p = 0.77), hair straightening/rebonding (OR 0.88, 95% CI 0.08-9.32; p = 0.92), hair perming (OR 1.41, 95% CI 0.89-2.23; p = 0.14), facial toner (OR 0.51, 95% CI 0.12-2.21; p = 0.37), or aftershave (OR 1.64, 95% CI 0.28-9.49; p = 0.58).
CONCLUSIONS: This meta-analysis strongly suggests that leave-on facial products, facial sunscreen and moisturizer, are associated with FFA. While the association with facial moisturizer did not persist when stratifying for female populations, gender sub-analyses remained significant for a facial sunscreen. There was no significant relationship found with hair products or treatments. These findings suggest a potential environmental etiology in the development of FFA, particularly UV-protecting chemicals.
METHODS: The Cochrane, PubMed, EMBASE, and Medline (Ovid) databases were searched for the relevant studies from the date of inception to August 2022. Case-control, cross-sectional, and cohort studies examining the effects of cosmetic/personal care product use on FFA, available in English full-text, were included. Analyses were performed using Review Manager, version 5.4. Results were reported as an odds ratio (OR) with a 95% confidence interval (CI); p values < 0.05 were considered significant.
RESULTS: Nine studies were included in our quantitative analyses, totaling 1,248 FFA patients and 1,459 controls. There were significant positive associations found for FFA and sunscreen (OR 3.02, 95% CI 1.67-5.47; p = 0.0003) and facial moisturizer (OR 2.20, 95% CI 1.51-3.20; p < 0.0001) use. Gender sub-analyses demonstrated a positive association for FFA and facial moisturizer in men (OR 5.07, 95% CI 1.40-18.32; p = 0.01), but not in women (OR 1.58, 95% CI 0.83-2.98; p = 0.16). Both gender sub-analyses were significantly positive for the association with facial sunscreen (Male OR 4.61, 95% CI 1.54-13.78, p = 0.006; Female OR 2.74, 95% CI 1.32-5.70, p = 0.007). There was no association found for a facial cleanser (OR 1.14, 95% CI 0.33-1.52; p = 0.51), foundation (OR 1.13, 95% CI 0.83-1.55; p = 0.21), shampoo (OR 0.49, 95% CI 0.22-1.10; p = 0.08), hair conditioner (OR 0.81, 95% CI 0.52-1.26; p = 0.35), hair mousse (OR 1.37, 95% CI 0.75-2.51; p = 0.31), and hair gel (OR 0.90, 95% CI 0.48-1.69; p = 0.74), hair dye (OR 1.07, 95% CI 0.69-1.64; p = 0.77), hair straightening/rebonding (OR 0.88, 95% CI 0.08-9.32; p = 0.92), hair perming (OR 1.41, 95% CI 0.89-2.23; p = 0.14), facial toner (OR 0.51, 95% CI 0.12-2.21; p = 0.37), or aftershave (OR 1.64, 95% CI 0.28-9.49; p = 0.58).
CONCLUSIONS: This meta-analysis strongly suggests that leave-on facial products, facial sunscreen and moisturizer, are associated with FFA. While the association with facial moisturizer did not persist when stratifying for female populations, gender sub-analyses remained significant for a facial sunscreen. There was no significant relationship found with hair products or treatments. These findings suggest a potential environmental etiology in the development of FFA, particularly UV-protecting chemicals.
摘要：
背景：额叶纤维化脱发（FFA）是一种影响额颞叶发际线的瘢痕性脱发。鉴于这种疤痕，免疫介导的卵泡破坏最常影响绝经后的高加索妇女，研究人员推测有激素和遗传成分；然而，FFA的病因尚不清楚。最近,皮肤科医生报告说，FFA的病例可能是由化妆品引起的，如防晒霜和洗发水。因此,本系统综述和荟萃分析旨在首次分析FFA与化妆品/个人护理产品和治疗方法之间的关系，包括防晒霜,保湿剂,基金会,洗发水,护发素,头发慕斯,发胶,染发剂,头发拉直/重新粘合，化学/激光面部修复，须后水,和洗面奶。
方法：Cochrane，PubMed,EMBASE,和Medline(Ovid)数据库从研究开始之日起至2022年8月的相关研究进行了搜索.病例控制,横截面,和队列研究检查化妆品/个人护理产品的使用对FFA的影响，以英文全文提供，包括在内。使用ReviewManager进行分析，版本5.4。结果报告为比值比（OR），置信区间为95％（CI）；p值<0.05被认为是显着的。
结果：我们的定量分析包括9项研究，共有1,248名FFA患者和1,459名对照。发现FFA和防晒霜（OR3.02，95％CI1.67-5.47；p=0.0003）和面部保湿剂（OR2.20，95％CI1.51-3.20；p<0.0001）的使用存在显着正相关。性别分分析显示男性FFA和面部保湿剂呈正相关(OR5.07,95%CI1.40-18.32;p=0.01),但女性并非如此(OR1.58，95%CI0.83-2.98；p=0.16)。两种性别分分析均与面部防晒霜呈显著正相关(男性OR4.61,95%CI1.54-13.78,p=0.006;女性OR2.74,95%CI1.32-5.70,p=0.007)。没有发现洗面奶的相关性（OR1.14，95％CI0.33-1.52；p=0.51），地基(OR1.13，95%CI0.83-1.55；p=0.21)，洗发水（OR0.49，95%CI0.22-1.10；p=0.08），护发素（OR0.81，95%CI0.52-1.26；p=0.35），头发摩丝(OR1.37，95%CI0.75-2.51；p=0.31)，和发胶(OR0.90，95%CI0.48-1.69；p=0.74)，染发剂（OR1.07，95%CI0.69-1.64；p=0.77），头发拉直/重新粘合（OR0.88，95%CI0.08-9.32；p=0.92），烫发（OR1.41，95%CI0.89-2.23；p=0.14），面部爽肤水（OR0.51，95%CI0.12-2.21；p=0.37），或须后水（OR1.64，95%CI0.28-9.49；p=0.58）。
结论：这项荟萃分析强烈表明，保留面部产品，面部防晒霜和保湿霜，与FFA有关。虽然对女性人群进行分层时，与面部保湿剂的关联并不持续，性别分分析对于面部防晒霜仍然具有重要意义。没有发现与头发产品或治疗的显着关系。这些发现表明FFA发展中潜在的环境病因，特别是保护紫外线的化学品。
方法：Cochrane，PubMed,EMBASE,和Medline(Ovid)数据库从研究开始之日起至2022年8月的相关研究进行了搜索.病例控制,横截面,和队列研究检查化妆品/个人护理产品的使用对FFA的影响，以英文全文提供，包括在内。使用ReviewManager进行分析，版本5.4。结果报告为比值比（OR），置信区间为95％（CI）；p值<0.05被认为是显着的。
结果：我们的定量分析包括9项研究，共有1,248名FFA患者和1,459名对照。发现FFA和防晒霜（OR3.02，95％CI1.67-5.47；p=0.0003）和面部保湿剂（OR2.20，95％CI1.51-3.20；p<0.0001）的使用存在显着正相关。性别分分析显示男性FFA和面部保湿剂呈正相关(OR5.07,95%CI1.40-18.32;p=0.01),但女性并非如此(OR1.58，95%CI0.83-2.98；p=0.16)。两种性别分分析均与面部防晒霜呈显著正相关(男性OR4.61,95%CI1.54-13.78,p=0.006;女性OR2.74,95%CI1.32-5.70,p=0.007)。没有发现洗面奶的相关性（OR1.14，95％CI0.33-1.52；p=0.51），地基(OR1.13，95%CI0.83-1.55；p=0.21)，洗发水（OR0.49，95%CI0.22-1.10；p=0.08），护发素（OR0.81，95%CI0.52-1.26；p=0.35），头发摩丝(OR1.37，95%CI0.75-2.51；p=0.31)，和发胶(OR0.90，95%CI0.48-1.69；p=0.74)，染发剂（OR1.07，95%CI0.69-1.64；p=0.77），头发拉直/重新粘合（OR0.88，95%CI0.08-9.32；p=0.92），烫发（OR1.41，95%CI0.89-2.23；p=0.14），面部爽肤水（OR0.51，95%CI0.12-2.21；p=0.37），或须后水（OR1.64，95%CI0.28-9.49；p=0.58）。
结论：这项荟萃分析强烈表明，保留面部产品，面部防晒霜和保湿霜，与FFA有关。虽然对女性人群进行分层时，与面部保湿剂的关联并不持续，性别分分析对于面部防晒霜仍然具有重要意义。没有发现与头发产品或治疗的显着关系。这些发现表明FFA发展中潜在的环境病因，特别是保护紫外线的化学品。
