Frontal Fibrosing Alopecia: A Closer Look at Pregnancy-related issues

Frontal Fibrosing Alopecia (FFA): What do we know so far about pregnancy and fertility-related issues?

FFA is a scarring alopecia which has both a a hormonal and immune basis. The suspected hormonal alterations have promoted evaluation of whether women with FFA have different pregnancy histories or differences in the age of menopause.

Buendia-Castano and colleagues conducted a case control study in 2018 to better assess the factors potentially associated with the development of FFA. The authors assessed responses to questions pertaining to many aspects of patient’s gynaecological history including pregnancy, breastfeeding, and menopausal status.

The authors found that there was no difference between the number of pregnancies, age at first pregnancy and length of time the mothers breastfed in women with FFA compared to women without FFA. It’s important to note that much of this information comes from interviewing women who developed FFA in their 50s - long after they had completed their families.

The main difference in this study however was that women with FFA experienced menopause appropriately two years earlier than women without FFA. Other studies, albeit not all, have suggested that FFA may be associated with early menopause and in some cases even premature menopause (menopause before age 40). The study by Buendia-Castano and colleagues did not find differences in the number of children women with FFA had, or rates of in vitro fertilization (IVF) or rates of fertility treatments compared to controls. This suggests that the genes or factors associated with FFA may not directly impact fertility - at least the genes that drive what I refer to as classical late onset FFA.

A key area for which knowledge is lacking is what are the clinical factors associated with FFA that develops before age 40 and whether fertility is in fact altered in this particular age group. I call this early onset FFA. Is fertility decreased in a woman who develops FFA at age 32 and plans to get pregnant in the future. We don’t really have enough data yet on the clinical features of FFA in women who develop FFA between 25-40.

Reference

Buendia- Castano et al. 2018.