Frontal Fibrosing Alopecia in Males: Is it more than a Hair Disease?

Vitiligo, Lichen Sclerosis, Oral Lichen Planus and Nail Disease Among the Features of Male FFA

Frontal fibrosing alopecia (FFA) is a scarring alopecia that is more significantly more common in women than men. 95-99% of cases of FFA occur in women and just a small proportion (1-5%) occur in men. A new study published in the British Journal of Dermatology highlights key features of male frontal fibrosing alopecia.

 Rayinda and colleagues described 17 male cases of FFA seen at the St John’s Institute of Dermatology, London, UK. Interesting, the median age of patients was 44 years which was found to be much lower than the median age of 66 years noted in the authors female FFA patients.

In addition to scalp hair loss, other sites were commonly involved. Eyebrow loss was present in 65 % of patients (11 of 17 patients), eyelash loss in 12 % (2 of 17 patients)., limb hair loss in 59 %  (10 of 17 patients),  and facial hair loss in 65 %  (11 of 17 patients). Facial papules were present in 47 % ( 8 of 17 patients).

Systemic Associations in Male FFA

A number of medical conditions were also present in males with FFA. Oral lichen planus was present in 6 % of patient  (1 of 17 patients), vitiligo in 6 %  (1 of 17 patients) and lichen sclerosus was present in 6%  (1 of 17 patients). Nail ridging was present in 6 %. Androgenetic alopecia was noted in 18 %  (3 of 17 patients).

Lab Abnormalities in Male FFA

Lab abnormalities were studied. Low testosterone was present in 18 %  (3 of 17 patients), abnormal SHGB in 24 %  (4 of 17 patients). Overall, the data are similar for the most part to the other FFA studies in males.

Conclusion

This is an interesting study and highlights several important findings. The study shows that male FFA occurs at younger ages than female FFA. It further highlights a number of possible autoimmune associations that require further study including vitiligo, lichen sclerosus, oral lichen planus and nail lichen planus. It further supports a number of hormonal alterations as well although the study is too small to really get a sense of whether such hormonal alternations are more common in FFA or less common in FFA than seen in the general population.

Although there is some evidence to support that FFA is largely a scalp disease with limited systemic associations, this study would support that FFA may in fact have a number of systemic autoimmune associations.

REFERENCE

Rayinda T et al. Clinical characteristics of male frontal fibrosing alopecia: a single-centre case series from London, UK. Br J Dermatol. 2022 Jan;186(1):195-197.