New Data in One of the Largest FFA Studies to Date

New Study of 490 Patients Shows Interesting Information about Frontal Fibrosing Alopecia (FFA)

Researchers from France and Germany performed an observational, cross-sectional study to identify demographic and health characteristics associated with the severity of FFA. In total they analyzed data from 490 patients with FFA, of which 95 % were female and 84 % were post menopausal. I was interested to read this paper as it represents one of the largest studies to date.

The main findings that intriqued me were the following

1. There was  a high incidence of thyroid disease in women with FFA. Specifically 35 % of women reported thyroid diasese which 9 times higher than the general population.

2. Cholesterol levels were the same as the general population. I’m continually wondering about the degree fo metabolic dysfunction in patients and this was interesting to see. 47 % of patients with FFA had lipid abnormalities but this was not really higher than the general population.

3. Nail lichen planus was rare. We know that for scalp lichen planopilaris (LPP), the incidence of nail disease is reported to be fairly high. It was interesting to note that frequency of nail disease in patients with FFA in this study was acutally quite low

4. Mucosal lichen planus was also uncommon in FFA patients. Similar to nail LP, mucosal LP (oral and vaginal) was quite low as well. In this study on 4 % of patients had mucocal LP.

5. The use of facial moisturizers did not seem to be associated with worse disease. In this study,  the majority of patients reported regular use of a facial moisturizer (98% of women and 73% of men) and a facial sunscreen (55% of men and 68% of women). In this study  the regular use of hair colorants and hairspray was asosicated with lower disease activity (LPPAI values). The jury is still out as to whether or not these cosmetic products really cause problems

 6. The hormonal status of most FFA patients was mostly normal. When abnormal estrogen levels were found it was associated with abnormal testosterone values suggesting these two go together somehow. Interestingly, the authors reported that abnormal estrogen and testosterone values were strongly associated with lesser disease activity.

7. In this particular study, the authors found that the incidence of rosacea in FFA patients was less common than the general population. This finding goes against previous studies.  It seems we don’t have a clear handle on this information quite yet.



Kanti et al. Frontal fibrosing alopecia: demographic and clinical characteristics of 490 cases.
J Eur Acad Dermatol Venereol. 2019 Jun 9. doi: 10.1111/jdv.15735. [Epub ahead of print]



Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Whistler office at 604.283.1887

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