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UNASSIGNED: Frontal fibrosing alopecia (FFA) is an important cause of scarring alopecia seen mostly in post-menopausal women but sometimes in pre-menopausal women and men. Although considered a variant of lichen planopilaris due to its histopathological characteristics, it has distinct clinical features and associations, which make it a unique entity. We hereby report a series of patients with FFA from North-East India.
UNASSIGNED: This study aimed to analyse the clinical and histopathological characteristics of FFA.
UNASSIGNED: We retrospectively analysed clinical records and histopathological features of FFA cases diagnosed in the Dermatology Outpatient Department from April 2013 to February 2023.
UNASSIGNED: A total of 21 patients, who were diagnosed with FFA from April 2013 to February 2023, were analysed. Of these, 19 patients were female, with a male-to-female ratio of 9.5:1. The mean age of study population was 48.33 years. The majority of the patients were from the post-menopausal age group (15/19 females, 78.94%). Lichen planus pigmentosus (6, 28.57%) was the most commonly associated disease, followed by androgenetic alopecia and lichen planopilaris (2 each, 9.52%). The main histological features noted were perifollicular lymphocytic infiltrate in 18 (85.71%), followed by hydropic degeneration of basal follicular keratinocytes in 15 (71.42%) and melanin incontinence in 14 (66.66%) patients.
UNASSIGNED: Our study is the first study from North-East India focusing on the clinical presentation and histopathological characteristics of FFA. Furthermore, with respect to the recent development in FFA, our study attempted to determine the clinical significance of the proposed criteria for the diagnosis of FFA patients by Tolkachjov et al. (2018), viz. International FFA Cooperative Group Criteria (2021).

BACKGROUND: Frontal fibrosing alopecia (FFA) is a cicatricial alopecia with rapid epidemic growth. However, there is no agreement on the best therapeutic approach.
OBJECTIVE: To compare the therapeutic effects of finasteride as a first-line systemic treatment of FFA versus hydroxychloroquine as a relatively safe and effective immunosuppressive drug.
METHODS: Thirty-four female FFA patients were randomly assigned to receive either 400 mg/day of hydroxychloroquine or 2.5 mg/day of finasteride for 6 months. Topical treatments in both groups include pimecrolimus, mometasone, and minoxidil. Treatment efficacy was evaluated using the Frontal Fibrosing Alopecia Severity Score (FFASS), photography, and trichoscopy after 3 and 6 months.
RESULTS: Both the finasteride and hydroxychloroquine groups showed significant improvements in FFASS and trichoscopic scores (p < 0.01). However, there was no significant difference between the two groups during the study. Photographic assessment showed that more than 60% of patients in both groups had improved without statistically significant differences between the two groups.
CONCLUSIONS: Both finasteride and hydroxychloroquine are equally effective, safe, and well-tolerable for treating FFA patients.

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(1) Background: Frontal fibrosing alopecia (FFA) is a scarring alopecia that predominantly affects postmenopausal women; (2) Methods: A retrospective, observational, single-center study was conducted in the Hospital General Universitario in Ciudad Real, Spain, including all patients diagnosed with FFA between 2010 and 2021; (3) Results: A total of 306 patients (296 women and 10 men) were included in our study. The mean age of onset was 59.5 years. The severity of this disease was evenly distributed between mild (147 patients) and severe (149 patients) forms. There was a positive, statistically significant, medium correlation between the severity of the disease and its time of progression. Moreover, hypothyroidism was present in 70 patients (22.9%) and classic signs of concomitant lichen planopilaris were observed in just 30 patients (9.8%), while other forms of lichen planus were uncommon. The estimated prevalence in our population is 0.15% and the incidence is 15.47 new cases per 100,000 inhabitants; (4) Conclusions: The time of progression was positively correlated with the severity of FFA. However, the presence of clinical signs, such as inflammatory trichoscopic signs, was not associated with the progression of this condition.

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BACKGROUND: Frontal fibrosing alopecia (FFA) is a scarring alopecia in which the exact etiopathogenesis has not been completely elucidated and the available treatments are not very effective. Plasma rich in growth factors (PRGF) has shown to induce folliculogenesis in hair loss related disorders. However, the scientific evidence when facing FFA is scarce.
OBJECTIVE: The aim of this study was to retrospectively analyze the adjuvant use of PRGF compared to the conventional treatment in the management of FFA.
METHODS: Participants with clinically diagnosed FFA who had been treated with either conventional therapy (Control Group) or conventional therapy combined with PRGF (PRGF Group) were identified from the center\'s medical records. The clinical assessment was based on the \"Frontal Fibrosing Alopecia Severity Score\" (FFASS), which was fulfilled during a period of two and 4 years.
RESULTS: This study included 118 patients with clinically diagnosed FFA (Control Group: 57 and PRGF Group: 61). No adverse effects related to the treatments were observed. Both treatments showed to halt the steady progression of hair loss compared to baseline. PRGF treatment also induced significant hair regrowth compared to the Control Group. The scalp inflammation was reduced in response to treatments. The FFASS score indicated that PRGF Group improved the symptoms and severity of FFA in a significant manner.
CONCLUSIONS: The adjuvant use of PRGF may exert long-term beneficial effects on hair loss reduction and might reduce the symptoms and severity of FFA.

Background Frontal fibrosing alopecia (FFA) and lichen planopilaris (LPP) is scarring alopecias with limited evidence supporting their treatment options. We investigated the use of low-dose naltrexone (3 mg oral daily) as adjunctive therapy in the treatment of FFA and LPP. Methods A single-center, uncontrolled open-label prospective study was performed, with 26 patients who took low-dose naltrexone for one year included in the per-protocol analysis. Both patient-reported (pruritus and burning/pain) and physician-assessed (erythema, scale, and scalp involvement) outcomes were analyzed. Results There were decreases in erythema and scale for the overall longitudinal outcomes using linear mixed effects model analysis. However, only erythema had a significant decrease at 12 months compared with baseline. Mean erythema decreased by 0.93 at 12 months compared with baseline on a 0-3-point scale (p<0.0001, 95% mean CI [-1.32, -0.53]). There was no statistically significant difference comparing 12 months to baseline for the other outcomes including pruritus, burning/pain, and scalp involvement. Limitations include the possibility of spontaneous stabilization, concurrent medications, a small sample size with limited racial diversity, and mild subjective symptoms at baseline. Conclusion Our study supports further investigation of oral low-dose naltrexone as adjunctive therapy in the treatment of FFA and LPP if there is prominent erythema, and possibly scale.

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