Scalp Sweating in Frontal Fibrosing Alopecia (FFA): is there a link?

Is excessive facial & scalp sweating part of frontal fibrosing alopecia ?

I’ve selected this question below for this week’s question of the week. It allows us to review some concepts related to excessive sweating of the scalp and face among patients with FFA.

QUESTION

I am 59 years and was diagnosed with FFA five years ago. Since I was a teenager I have had problems with excessive sweating around my scalp and face. Is there a relationship between the two? And is there any way to stop the sweating? Thank you!

ANSWER

Thanks for the question. Yes, there appears to be a link but we don’t yet know how commonly it occurs. I always recommend a really good history and examination patients with FFA who report excessive sweating. It seems to be true that there is some kind of a link - but we don’t want to miss other medical conditions that give excessive sweating. So before jumping to discussing treatments for the sweating, I always advise to pause and make sure other conditions are not missed. This is especially true if the sweating is generalized (meaning all over the body) as opposed to just the scalp. There are probably 30 medical conditions that can cause excess sweating! A variety of conditions including thyroid issues, infections, cancers, diabetes, endocrine issues, and medications can all carry the potential to cause generalized or ‘diffuse’ sweating.

Scalp Sweating in FFA

It’s my personal belief that this link between scalp sweating and FFA has not been given the attention it deserves - or even the recognition. I’m not even sure that all hair experts are up to acknowledging the link between scalp sweating and FFA. Now, granted excess sweating does not occur in all patients with FFA - but it’s certainly something that not uncommon.

Interestingly, this is something we reviewed many years ago. You might find this link helpful.

Dr Harries and Colleagues Study of 2016

A 2016 study reported 11 women with FFA reported increased sweating in the areas of hair loss. Many treatments seemed to be helpful including topical steroids, steroid injections, and antibiotics. Interestingly, botulinum toxin treatments (Botox) was also found to be helpful.

I have seen many patients with refractory sweating improve with steroid injections and doxycycline and many who improve with BOTOX injections. I do think that it’s important to keep BOTOX injections in the plan if other treatments don’t help. Botox is commonly used to treat sweating issues of many parts of the body including the underarm area and palms (for excess hand sweating).

We still don’t have all the answers as to why some women with FFA develop this sweating. Sweating is controlled in part by the nervous system and this raises the possibility that a specific type of inflammation known as ‘neurogenic’ inflammation may be relevant in FFA.

More research is needed in this area.

Reference

Harries et al. Frontal fibrosing alopecia and increased scalp sweating: Is neuorgenetic inflammation the common link. Skin Appendage Disord May 2016; 1(4):179-84