Does HRT Use Affect FFA?

HRT Use for Women with FFA

 
I’ve selected this question below for this week’s question of the week. It allows us to review some concepts in the use of hormone replacement therapy for women with FFA.

QUESTION

Hello Dr Donovan

I was diagnosed very recently with FFA. It’s clear to me now that I have had it for at least 6 years. I started treatment for FFA and at the same time started treatment with HRT. I have been thinking that HRT has accelerated my hair loss. Is this even possible? My dermatologist feels that HRT should help everything!

Answer

Many women with FFA take HRT. That does not mean that HRT causes FFA nor helps FFA. We know a few things about HRT in women with FFA. First, it seems that women with FFA use HRT quite often. In 2018, Imhof et al showed that 63.3% of women with FFA had a history of hormone replacement therapy.

The use of HRT varies dramatically across the world. Women in the US use HRT more often followed by UK and Scandanavia. HRT is dramatically less women among women living in central Euopean countries. In the US, HRT use by post menopausal women has declined from 22 % in 1999 to 5 % in 2010.

In 2019, Moreno-Arrones et al showed that women with FFA were almost two times more likely to use HRT than women who were similar age. (OR = 1.76; 95% CI 1.11-2.8). Again, it’s important not to conclude here that HRT causes FFA. For example, the same study showed that women with FFA were 2 times more likely to have hypothyroidism (OR = 1.73; 95% CI 1.11-2.69). We wouldn’t dare conclude that hypothyroidism causes FFA only that they are possibly somehow linked or connected.

We also know from studies by Meinhard et al that women with FFA are more likely to use HRT than women with LPP. That’s not surprising given that women with FFA tend to be older than women with FFA. But again, there could be something specific about the changes in FFA that prompt HRT.

We know that women with FFA are more likely to expereince early menopause. In 2014, Vano-Galvan showed that 14 % of women with FFA experienced early menopause. This is much higher than the 1 % risk of early menopause in the general population. A 2018 case control study by Buendia-Castrano and colleagues also showed that menopause occured earlier in women with FFA. This data came from examining records of 104 female FFA patients and 208 controls.

Does HRT use Affect the Course of FFA?

All in all, most believe that HRT does not impact the course of FFA (Kossard et al, 1997).

REFERENCE

Kossard S et al. Postmenopausal frontal fibrosing alopecia: a frontal variant of lichen planopilaris.

J Am Acad Dermatol. 1997 Jan;36(1):59-66.

Meinhard et al. Lichen planopilaris: Epidemiology and prevalence of subtypes - a retrospective analysis in 104 patients. Dtsch Dermatol Ges . 2014 Mar;12(3):229-35, 229-36.

O M Moreno-Arrones et al. Risk factors associated with frontal fibrosing alopecia: a multicentre case-control study. Clin Exp Dermatol . 2019 Jun;44(4):404-410.

Imhof RL et al. Frontal Fibrosing Alopecia in Women: The Mayo Clinic Experience With 148 Patients, 1992-2016 Mayo Clin Proc. 2018 Nov;93(11):1581-1588.

Vañó-Galván S et al. Frontal fibrosing alopecia: a multicenter review of 355 patients. J Am Acad Dermatol 2014 Apr;70(4):670-678.

Buendia-Castrano D et al. Hormonal and Gynecological Risk Factors in Frontal Fibrosing Alopecia: A Case-Control Study. Skin Appendage Disord. 2018 Oct;4(4):274-276. doi: 10.1159/000484210. Epub 2017 Dec 8.