Frontal fibrosing alopecia in men: is it any different? (2022)

Type of publication:
Conference abstract

*Jacob M.A.; *Jain D.; *Shaw R.;

British Journal of Dermatology. Conference: 102nd Annual Meeting of the British Association of Dermatologists. Glasgow United Kingdom. 187(Supplement 1) (pp 100), 2022. Date of Publication: July 2022.

Frontal fibrosing alopecia (FFA) is a scarring disease characterized by a receding frontotemporal hairline associated with varying degrees of eyebrow alopecia. It is usually seen in postmenopausal women. FFA has occasionally been reported in men, and can be confused with androgenetic alopecia, and therefore present quite late to the clinician. Although, histopathologically, FFA is similar in both sexes, there are a few differences clinically and with regard to treatment. We aimed to highlight these characteristics. A 51-year-old male presented with hair loss of 3 years' duration involving the eyebrows, sideburns and beard, followed by frontotemporal recession of the hairline. He reported a similar history in his mother and maternal aunt. In addition, he was known to have testosterone deficiency with low levels of total and free testosterone and sex hormone binding globulin, and was on replacement therapy. His remaining serology, including thyroid profile, was within normal limits. Clinical examination showed patchy alopecia of the eyebrows, eyelashes, sideburns and beard. There was frontotemporal recession of hairline along with loss of follicular orifices and perifollicular erythema. Additionally, he had diffuse thinning of the hair over the vertex and nonscarring alopecia over his extremities. A punch biopsy showed end-stage scarring alopecia with perifollicular fibrosis and 'backing off' of the surrounding lichenoid inflammatory infiltrate consistent with lichen planopilaris. A clinical diagnosis of FFA was made and the patient was started on hydroxychloroquine tablets along with 1% topical pimecrolimus twice daily over the patches of alopecia on the face. Common sites of hair loss in men include the sideburns, beard, eyebrows, eyelashes and occipital hair, and facial hair loss may precede eyebrow loss, as was the case in our patient. Facial papules, androgenetic alopecia and loss of body hair are more often observed in men with FFA than in women. In addition, the loss of body hair and eyelashes and the presence of facial papules have been associated with more severe forms of FFA and can be used as a prognostic indicator. Autoimmune conditions like thyroid disease and lichen planus are uncommon in males, although androgen deficiency has been linked to FFA in males in various studies. In addition, hormone-blocking drugs can contribute to FFA. Therefore, it is very important to keep this in mind during history and examination and perform relevant blood tests. In addition, treatment with minoxidil may provide better results in males.