Frontal Fibrosing Alopecia Associated with Significantly Lower Quality of Life

Aida Varghaei, PhD

A recent investigation into frontal fibrosing alopecia (FFA) found that more than half of all patients affected by the skin condition scored higher on the Dermatology Life Quality Index (DLQI), suggesting a lower quality of life.

Naturally, the spread of the disease to the facial, nail, and limb regions of the body resulted in even lower quality of life.

Frontal fibrosing alopecia was first detailed in 1994, making it a relatively new dermatologic discovery. There are a myriad of different clinical manifestations and treatment responses associated with the disease, and a significant increased incidence of FFA has been recorded in recent years.

Beyond that, much about FFA is still unknown.

For this study, an investigative team led by Aida Varghaei, PhD, of the Autoimmune Bullous Diseases Research Center of Tehran University of Medical Sciences, sought to determine the severity of FFA in patients of the Razi Skin Hospital in 2019-2020, as well as the implications of the disease on health-related quality of life (HRQOL).

Inclusion criteria were comprised of a confirmed diagnosis of FFA and histopathological findings without any previous medical history of other chronic diseases or mental health problems.

The team utilized the DLQI and Short Form 36 questionnaires to gauge HRQOL, and the Frontal Fibrosing Alopecia Severity Score Index (FFASI) was used to determine disease severity.

Overall, 49 patients with FFA were enrolled in the study, nearly all of whom (98%) were female. The age range of these patients was 30-65 years old, and the duration of diagnosis was between 6 and 60 months. A majority of patients were treated for FFA in the past (69.4%).

Notably, temporal and frontal involvement of FFA were frequently cited (44.9%), and facial papules were seen in 18 patients (37.5%).

The mean FFASI score was 34.75, while the mean score of DLQI was 2.25 and the mental health component score of SF-36 was between 21.18 and 95.8. No significant association between these scores were observed in the available covariant of the study including age, diagnosis duration, gender, level of education, and treatment.

However, a significant related between DLQI scores and facial papules was observed (P=0.03), and a significantly higher DLQI score was seen in patients with nail, limb, and flexural involvement (P=0.013).

Despite the lack of a large patient population, the investigative team believed their study was the first to illustrate the complications of FFA through the concomitant use of 3 indices including disease severity, site of involvement, and various covariants related to HRQOL.

"Despite the promising effects of isotretinoin and dutasteride in recent studies, the outlook for FFA remains unclear," the team wrote. "In order to help FFA patients whose quality of life is impaired, psychological relief methods are essential."

The study, "Assessment of health-related quality of life in patients with frontal fibrosing alopecia," was published online in the Journal of Cosmetic Dermatology.