The Use of Oral Contraceptive Raises the Risk of FFA - At Least in Some Women

Oral Contraceptives and Frontal Fibrosing Alopecia

In 2019, we talked about a groundbreaking study examining 4 genes that affect the risk of a female developing frontal fibrosing alopecia. These genes included HLA B, CYP1B1, ST3ST3GAL1 and SEMA4B. For review, see the study link below.

Since the publication of this 2019 study, significant interest has been given to CYP1B1 gene. This gene is involved in estrogen metabolism in addition to other functions.

A new study by Rayinda and colleagues found that women who had a specific version of the CYP1B1 gene (specifically the allele that encodes an asparagine at position 453 of CYP1B1 gene) were more likely to develop FFA if they had also used oral contraceptives in the past. Women with these CYP1B1 alleles who did not use OCPs did not have this risk.

The study population included 489 female FFA patients, with a mean age of 65.8 years, of whom 75.7% had a history of OCP use. Data was compared to a control group which consisted of 34,254 women (ie matched 1:66), with a mean age of 65.0 years, and 91.0% reported previous OCP use.

Comments

This is an interesting study and puts oral contraceptive pills in the spotlight as a potential contributor to FFA - at least in women with a specific mutation of CYP1B1. We don’t have any data on what types of OCPs are more likely to do this than others, and we don’t know if some OCPs are safer than others. Furthermore, the effects of other hormonal treatments like HRT are not known.

We are not yet in a position to offer genetic testing to women with FFA or to family members. However, this study will fuel additional studies to examine the role of estrogen-containing compounds in FA

References

Rayinda T, McSweeney SM, Christou E, et al. Gene-environment interaction between CYP1B1 and oral contraception on frontal fibrosing alopecia. JAMA Dermatol. 2024.

Christos Tziotzios et al. Genome-wide association study in frontal fibrosing alopecia identifies four susceptibility loci including HLA-B*07:02. Nature 2019. Online March 8, 2019 -