National Scarring Alopecia Awareness Month (Day 8, Fact 8): Specific Types of Scarring Alopecia Often have Specific Age Ranges that the Disease Starts.

Scarring alopecias affect individuals of all ages.  Some scarring alopecias are more likely to develop after age 35 and some are more likely to develop before age 35.

Dissecting cellulitis and discoid lupus are scarring alopecias that often affect patients in their 20s and 30s.  Folliculitis decalvans often starts in the 30s and 40s just a slight bit ahead of the average age that lichen planopilaris and central centrifugal cicatricial alopecia start. Frontal fibrosing alopecia typically starts in the mid 40s to early 50s. Erosive pustular dermatosis is more commonly a condition in the 60s, 70s and 80s.

There are of course a wide variation in the ages that these scarring alopecias present and the above ages are typical ranges rather than any sort of rules. Some women and men in the 20s are developing FFA and some in teenagers have been diagnosed with CCCA. One must never think scarring alopecias follow exactly what the textbooks outline. 

What to consider with early onset scarring alopecia outside the normal range?

The age range is important especially when the clinician thinks to himself “Oh this patient is younger than we typically see with this condition”

1) First, one must question whether they truly have the right diagnosis. They might of course have the correct diagnosis but many rare mimickers exist. A variety of rare genetic disorders are associated with scarring alopecia so one must always think carefully about these when scarring aloepcias are diagnosed in children.

2) Second early onset scarring alopecias outside of the normal age range may affect prognosis. For example early onset folliculitis decalvans (before 25) has been associated with poor prognosis in some studoes and may require close follow up and aggressive treatment. 

3) Third, early onset disease may affect the type of work up and evaluation a patient receives. For example, early onset FFA may be associated with early menopause so women diagnosed with FFA before age 40 who want to have additional children or start a family should be referred to gynecology for review of ovarian reserve in my opinion.  Early onset discoid lupus in children may be associated with a greater risk for systemic lupus and these patients need close follow up.

4) Finally, the age of onset of a scarring alopecia gives researchers some insight into possible causes. The later and later in life a condition develops the more likely researchers are to feel than environmental factors play a role in the disease pathogenesis. 

REFERENCE

Arkin et al. The natural history of pediatric-onset discoid lupus erythematosus. J Am Acad Dermatol. 2015 Apr.

Vano-Galvan et al. Frontal fibrosing alopecia: a multicenter review of 355 patients. J Am Acad Dermatol. 2014 Apr.

Vano- Galvan et al. Folliculitis decalvans: a multicentre review of 82 patients. J Eur Acad Dermatol Venereol. 2015 Sep.