Eyebrow Loss in FFA: What type of prognostic factor is it?

Does eyebrow loss in FFA portend a poor prognosis?

A large proportion of patients (70-90%) with frontal fibrosing alopecia experience eyebrow loss. To date, very few studies have examined the clinical course of patients with eyebrow loss compared to those withouth eyebrow loss.

Dr Vano’s 2014 study suggested that eyelash loss, facial papules and body hair loss were important negative prognostic factors. His group proposed that eyebrow loss was a negative prognostic factor but perhaps a more mild negative prognostic factor.

Imhof RL et al. 2022

Authors of a new study set out to assess eyebrow involvement in patients with FFA, comparing outcomes for those with and without eyebrow loss.

To do so, the authors performed a retrospective chart review of patients with a diagnosis of FFA seen at their institution from January 1, 1992, through February 5, 2019. Patients with FFA were further stratified on the basis of eyebrow involvement. Treatments and outcomes were evaluated by review of clinical notes. Response to treatment was categorized using the following terminology:

a) unaltered disease progression (UDP)

b) slowing of disease progression (SDP)

c) disease stabilization (DS).

Results

A total of 224 patients with FFA were identified in the retrospective study. 95.5% were female and the mean age was 61.9 years (with a range, 27-90 years). Most patients presented with both scalp and eyebrow involvement (144, 64.3%). Just over one-third of patients ( 88 of 224, 39.3%) patients had total eyebrow loss.

Patients without Eyebrow Loss Have Better Outcomes

There were 111 patients with eyebrow involvement who pursued treatment at the author’s institution. Of those 111 patients, almost 50 % had unaltered disease progression (UDP). 28 (25.2%) experienced disease stabilization and 28 (25.2%) had slowing of diseaese progress.

Among patients without eyebrow involvement who pursued treatment at the authors’ institution, only one quarter had unaltered disease progression. 13 of 55 or 23.6%. 17 (30.9%) experienced disease stabilization and 25 (45.5%) had slowing of disease progression.

Overall, eyebrow involvement was significantly associated with unaltered disease progression (P <.0023). Patients with eyebrow involvement of their FFA experienced longer times to disease remission, with a mean and median of 812.1 and 730 days, respectively. In contrast, patients without eyebrow involvement had mean and median remission times of 502.8 and 193 days, respectively.

Comments/Conclusions

Overall, these data show that eyebrow loss in FFA is a negative prognostic factor. Patients with eyebrow loss have a more resistant disease that takes longer to become inactive.

REFERENCE

Imhof RL et al. Eyebrow hair loss as a prognostic factor for frontal fibrosing alopecia. JAAD Int. 2022 Aug 18;9:44-45.