Spontaneous Partial Reversal of Grey Hair in FFA

Does the FFA inflammation color the hairs ?

Two prior studies have suggested that partial reversal of grey hairs may be seen in some patients with FFA. A 2006 study by Defo and colleagues reported a 78 year old woman who had repigmentation of the scalp margins. She was not taking any medications but had used hydroxychloroquine for a period of 4 months total duration about 2 years prior. The authors proposed that FFA inflammation might trigger pigmentation.

A 2021 study by Pastor-Nieto et al published in the JEADV presented 7 women with FFA who had partial reversal of their grey hair. Repigmentation was observed in frontal and temporal/preauricular areas in all of the 7 patients and in the occipital region in three patients. In 3 patients, the hair pigmentation occurred before the diagnosis and in 4 patients repigmentation happened after the diagnosis during a follow up period ranging from 1-6 years after diagnosis. In these four patients, 1 had been treated with steroid injections, 1 had been treated with steroid injections and finasteride and 2 had been treated with clobetasol. 3 patient had repigmentation noted at the time of their first consultation. They had not received treatment for their FFA. The authors noted that eyebrows did not tend to be affected to a great degree with the FFA in these 7 women.

Baretto et al, JEADV 2022

A new report by Baretto et al presents a 62-year-old Caucasian healthy male with biopsy proven diagnosis of FFA who showed spontaneous partial reversal of canities (grey hair) on his first consultation. The authors presented nice photos of the man’s hair 5 years before diagnosis and at the time of the diagnosis showing a darkening up of hair.

Why does this phenomenon occur?

The pathomechanisms leading to hair follicle repigmentation are not clear, although some hypotheses have been proposed including one that melanocytes in hair follicles might be activated through inflammatory mediators, such as cytokines and reactive oxygen species, explaining hair repigmentation after an induced folliculitis.

REFERENCES

Barreto TM et al. Atypical frontal fibrosing alopecia presentation in a male patient associated with spontaneous reversal of canities. J Eur Acad Dermatol Venereol. 2022 Mar 12.

Defo D, Naouri M, Martin L, Esteve E. Repigmentation pilaire enbordure d’une alopecie frontale fibrosante. [Hair darkening close to apatch of frontal fibrosing alopecia]. Ann Dermatol Venereol 2006;133: 799–801

Pastor-Nieto MA, Van~o-Galvan S, Gomez-Zubiaur A, Jimenez-Blazquez E, Moreno-Arrones OM, Melgar-Molero V. Localized grey hair repigmentation (canities reversal) in patients with frontal fibrosing alopecia. J Eur Acad Dermatol Venereol 2021; 35: e408–e410.