Epidemiological and clinical features of pattern III frontal fibrosing alopecia (pseudo fringe type): a multicenter series of 38 patients
FFA patients can be classified in three different clinical patterns, each one presenting different prognosis. Pattern I was defined as a “linear pattern”, in which there is a uniform frontal hairline recession. Pattern II consists of a “zig-zag band-like” alopecia and decrease of hair density. Pattern III is described as FFA presenting “pseudo fringe sign”. Those patients had their original hairline spared by the inflammatory infiltrate. Pattern III has been considered as having the best prognosis among all of them. The number of patients described in literature with this pattern is scarce. The objective of this paper was to analyze the clinical and epidemiological features of pattern III FFA patients. A multicenter retrospective, descriptive study was designed among four centers of Brazil and Spain. Patients with a confirmed diagnosis of pattern III FFA were included. The diagnosis was performed based on the updated diagnostic criteria. A total of 38 patients (37 females, one male) with a mean age of 55 years (range 31-81) were included. Clinical and epidemiological data were retrieved from patients’ medical records. Use of hormonal therapy including oral contraceptives or dihydroepiandrostenidione was reported in 13/38 (34.2%), sunscreen use in 16/31 (51.6%), while use of facial cosmetics was informed in 18/31 (58.1%). Two patients declared family history of FFA. Body hair was affected in 7/32 (21.9%) patients, while eyebrow loss was observed in 15/38 (39.5%), and eyelash loss in 1/38 (2.6%). Lichen planus pigmentosus was associated in 2/38 (5.2%) and facial papules in 15/38 (39.5%). Concomitant autoimmune diseases were present in 4/29 (13.8%). Fitzpatrick´s phototype ranged from II to IV. Of all patients, 20/29 (69%) were premenopausal women. The results for age, gender, family history, body hair loss, lichen planus pigmentosus, autoimmune diseases associated, and phototype were similar to the two largest series from the literature. Use of hormones was not addressed by the other studies. Compared to the largest studies of FFA patients4,5, our cases showed less eyebrow loss (p<0.001) and eyelash loss (p<0.05). These findings, along with the higher frequency of premenopausal women, were consistent with the results of Moreno-Arrones et al2. On the other hand, we found a higher frequency of facial papules (p<0.001) in our series. The use of moisturizers was less frequent compared to the article by Kanti et al5 (p<0.001) and we had a higher proportion of premenopausal women (p<0.05). In conclusion, FFA patients with pattern III are more frequently premenopausal and with less eyebrows and eyelashes involvement than the rest of FFA patients. To the best of our knowledge, this is the first study analyzing the main features of pattern III FFA patients.