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Summary: Background: Frontal fibrosing alopecia (FFA) is a chronic cicatricial alopecia with an increasing incidence and unknown aetiology. Aim: To identify possible environmental and hormonal factors related to FFA. Methods: We conducted a multicentre case–control study paired by sex and age, and recruited 664 women (335 cases and 329 controls) and 106 men (20 cases and 86 controls). Study subjects completed an exhaustive questionnaire enquiring about pharmacological, environmental, hormonal, social, job exposure, lifestyle, drugs and diet factors to which they were exposed at least 5 years prior to the onset of the disease. Results: For women, there was a statistical association between alopecia and history of pregnancy (OR = 1.6; 95% CI 1.06–2.41), use of facial sunscreen (OR = 1.6; 95% CI 1.06–2.41) and hormone replacement therapy (HRT) (OR = 1.76; 95% CI 1.11–2.8) or raloxifene (no controls exposed therefore OR was not calculated), exposure to alkylphenolic compounds (OR = 1.48; 95% CI 1.05–2.08), and presence of rosacea (OR = 1.91; 95% CI 1.07–3.39), lichen planus pigmentosus (LPP) (OR = 5.14; 95% CI 1.11–23.6) or hypothyroidism (OR = 1.73; 95% CI 1.11–2.69). For men, there was a statistical association between alopecia and use of facial sunscreens (OR = 11.6; 95% CI 1.7–80.9) or antiageing creams (OR = 1.84; 95% CI 1.04–3.23). Conclusions: FFA seems to be associated with hormonal exposure (pregnancy, HRT and raloxifene), comorbidities (hypothyroidism, LPP and rosacea) and environmental factors (facial sunscreens, antiageing creams and occupational exposure). Further research is required to analyse the exact mechanism in which these environmental factors participate in the development of this alopecia. [ABSTRACT FROM AUTHOR]

Frontal fibrosing alopecia (FFA) is a primary scarring alopecia with a variable prognosis.[1] We previously analysed the 12-month progression of the disease in a cohort of 106 patients treated with oral dutasteride 0.5 mg three times weekly and topical clobetasol and observed that the age of the patient, age at diagnosis of the disease and the clinical pattern (linear, diffuse or pseudo-fringe pattern) were prognostic factors of hairline regression, which ranges from 0.1 to 2.6 cm according to previous studies.[[2]] In order to increase the external validity of those results, we conducted a multicentric study that analysed severity of the disease, measured by hairline regression, and the risk factors of FFA previously described.[5] Hairline regression was categorized into five stages (I-V) as previously reported.[1] Table shows treatment modalities of the patients; the combination of topical treatment (clobetasol propionate, tacrolimus and minoxidil) and oral dutasteride 0.5 mg three times a week was the most used therapy (82.4%). In conclusion, FFA severity seems to be associated with the age of the patient, age of onset of the disease, duration of the disease, low academic level and body mass index. [Extracted from the article]