W. Cranwell1,2, R. Sinclair2,3,4
Since its first description in 1994, frontal fibrosing alopecia has most often been described in postmenopausal white women. The incidence has increased approximately tenfold in the past decade. The aetiology is likely heterogeneous, with genetic, autoimmune, hormonal and environmental factors implicated. There is increasing evidence that sunscreen and leave-on skin care products are implicated in the pathogenesis of FFA.
We report a case of a 55-year-old premenopausal woman with clinically diagnosed FFA affecting the frontotemporal hairline and eyebrows. There was no significant medical history. She was initially managed with hydroxychloroquine 200 mg daily, novasone 0.1% ointment, and clobetasol dipropionate 0.05% ointment. Courses of minoxidil 1 mg daily, spironolactone 200 mg daily, cyclosporine 100 mg daily and serial intralesional triamcinolone did not arrest hair loss. After being advised to cease sunscreen use on the forehead, she experienced remarkable regrowth of the frontotemporal hairline within two months. This regrowth was sustained and density of her frontal hairline resulted in a favourable cosmetic outcome. The patient ceased cyclosporine and hydroxychloroquine without recurrence.
This case report further suggests a role of sunscreen in the pathogenesis and progression of hair loss in FFA. The patient achieved remarkable hair regrowth in an area of cicatricial alopecia and ceased immunosuppression medications without relapse. We now advise patients with FFA to consider alternative forms of sun protection on the forehead and use sunscreen only when the UV rating is significant. Advice regarding facial sunscreen use should be personalised base on the risk of melanoma and keratinocyte cancer of the head.