Clinicopathological Features of Frontal Fibrosing Alopecia (FFA) in 26 females: A Retrospective Study.

Background & Objective: FFA usually has a gradual subtle course and might be overlooked by physicians or misdiagnosed with other types of hair loss including androgenetic alopecia, traction alopecia, and other types of patterned alopecia. In this study, we described clinicopathological features of patients with FFA referring for skin biopsy. Methods: This is a retrospective cross-sectional study on 26 patients with a diagnosis of FFA based on clinicopathological features. Firstly, the demographic and clinical features of patients were extracted from an electronic database. Then, skin biopsy specimens were reviewed regarding the presence or absence of hair follicles, site and severity of infiltrations, and presence of fibrosis. Results: Most of the patients were over fifty years of age (57.7%) with a mean age of 50.73 ± 10.03 years. Frontal region involvement was observed in all of the cases. Eyebrow hair loss was observed in 38.5% of cases. The most frequent clinical findings were the absence of vellus hairs in frontotemporal regions (96.2%) and perifollicular erythema (92.3%). The most common pathological features were involvement of the vellus hairs (84.6%), replacement of follicular epithelium with fibrous sheath (80.8%), and destruction of sebaceous glands (69.2%). Peri-infundibular and peri-bulbar interface changes were observed in 50% and 61.5% of skin biopsies, respectively. Perifollicular fibrosis was demonstrated in half of the skin biopsies. Conclusion: FFA is most commonly observed in females after the 5th decade of life. The absence of vellus hairs and the replacement of follicular epithelium with fibrous sheath are the most common clinical and pathological features of the disease, respectively.