Frontal Fibrosing Alopecia: A Histopathological Comparison of the Frontal Hairline with Normal-Appearing Scalp
Abstract
:1. Introduction
2. Materials and Methods
3. Results
4. Discussion
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
- Vañó-Galván, S.; Saceda-Corralo, D.; Blume-Peytavi, U.; Cucchía, J.; Dlova, N.C.; Dias, M.F.R.G.; Grimalt, R.; Guzmán-Sánchez, D.; Harries, M.; Ho, A.; et al. Frequency of the Types of Alopecia at Twenty-Two Specialist Hair Clinics: A Multicenter Study. Ski. Appendage Disord. 2019, 5, 309–315. [Google Scholar] [CrossRef]
- Vañó-Galván, S.; Molina-Ruiz, A.M.; Serrano-Falcón, C.; Arias-Santiago, S.; Rodrigues-Barata, A.R.; Garnacho-Saucedo, G.; Martorell-Calatayud, A.; Fernández-Crehuet, P.; Grimalt, R.; Aranegui, B.; et al. Frontal fibrosing alopecia: A multicenter review of 355 patients. J. Am. Acad. Dermatol. 2014, 70, 670–678. [Google Scholar] [CrossRef]
- Porriño-Bustamante, M.L.; Fernández-Pugnaire, M.A.; Arias-Santiago, S. Frontal Fibrosing Alopecia: A Review. J. Clin. Med. 2021, 10, 1805. [Google Scholar] [CrossRef] [PubMed]
- Harries, M.J.; Meyer, K.; Chaudhry, I.; Kloepper, J.E.; Poblet, E.; Griffiths, C.E.; Paus, R. Lichen planopilaris is characterized by immune privilege collapse of the hair follicle’s epithelial stem cell niche. J. Pathol. 2013, 231, 236–247. [Google Scholar] [CrossRef] [PubMed]
- Harries, M.J.; Jimenez, F.; Izeta, A.; Hardman, J.; Panicker, S.P.; Poblet, E.; Paus, R. Lichen Planopilaris and Frontal Fibrosing Alopecia as Model Epithelial Stem Cell Diseases. Trends Mol. Med. 2018, 24, 435–448. [Google Scholar] [CrossRef]
- Kossard, S. Postmenopausal frontal fibrosing alopecia. Scarring alopecia in a pattern distribution. Arch. Dermatol. 1994, 130, 770–774. [Google Scholar] [CrossRef]
- Poblet, E.; Jiménez, F.; Pascual, A.; Piqué, E. Frontal fibrosing alopecia versus lichen planopilaris: A clinicopathological study. Int. J. Dermatol. 2006, 45, 375–380. [Google Scholar] [CrossRef] [PubMed]
- Ma, S.A.; Imadojemu, S.; Beer, K.; Seykora, J.T. Inflammatory features of frontal fibrosing alopecia. J. Cutan. Pathol. 2017, 44, 672–676. [Google Scholar] [CrossRef] [PubMed]
- Wong, D.; Goldberg, L.J. The depth of inflammation in frontal fibrosing alopecia and lichen planopilaris: A potential distinguishing feature. J. Am. Acad. Dermatol. 2017, 76, 1183–1184. [Google Scholar] [CrossRef] [Green Version]
- Porriño-Bustamante, M.L.; Fernández-Pugnaire, M.A.; Castellote-Caballero, L.; Arias-Santiago, S. Colour Doppler ultrasound study in patients with frontal fibrosing alopecia. Ski. Res. Technol. 2021, 27, 709–714. [Google Scholar] [CrossRef] [PubMed]
- Mirmirani, P.; Willey, A.; Headington, J.T.; Stenn, K.; McCalmont, T.H.; Price, V.H. Primary cicatricial alopecia: Histopathologic findings do not distinguish clinical variants. J. Am. Acad. Dermatol. 2005, 52, 637–643. [Google Scholar] [CrossRef] [PubMed]
- Saceda-Corralo, D.; Desai, K.; Pindado-Ortega, C.; Moreno-Arrones, O.M.; Vañó-Galván, S.; Miteva, M. Histological evidence for epidermal and dermal atrophy of the alopecic band in treatment-naïve patients with Frontal Fibrosing Alopecia. J. Eur. Acad. Dermatol. Venereol. 2022, 35, e47–e49. [Google Scholar] [CrossRef]
- Pindado-Ortega, C.; Perna, C.; Saceda-Corralo, D.; Fernández-Nieto, D.; Jaén-Olasolo, P.; Vañó-Galván, S. Frontal fibrosing alopecia: Histopathological, immunohistochemical and hormonal study of clinically unaffected scalp areas. J. Eur. Acad. Dermatol. Venereol. 2020, 34, e84–e85. [Google Scholar] [CrossRef] [PubMed]
- Doche, I.; Romiti, R.; Hordinsky, M.K.; Valente, N.S. “Normal-appearing” scalp areas are also affected in lichen planopilaris and frontal fibrosing alopecia: An observational histopathologic study of 40 patients. Exp. Dermatol. 2020, 29, 278–281. [Google Scholar] [CrossRef] [PubMed]
- Chew, A.L.; Bashir, S.J.; Wain, E.M.; Fenton, D.A.; Stefanato, C.M. Expanding the spectrum of frontal fibrosing alopecia: A unifying concept. J. Am. Acad. Dermatol. 2010, 63, 653–660. [Google Scholar] [CrossRef] [PubMed]
- Sperling, L.C. Hair density in African Americans. Arch. Dermatol. 1999, 135, 656–658. [Google Scholar] [CrossRef] [Green Version]
- Miteva, M.; Sabiq, S. A New Histologic Pattern in 6 Biopsies from Early Frontal Fibrosing Alopecia. Am. J. Dermatopathol. 2019, 41, 118–121. [Google Scholar] [CrossRef]
- Gálvez-Canseco, A.; Sperling, L. Lichen planopilaris and frontal fibrosing alopecia cannot be differentiated by histopathology. J. Cutan. Pathol. 2018, 45, 313–317. [Google Scholar] [CrossRef]
- López-Pestaña, A.; Tuneu, A.; Lobo, C.; Ormaechea, N.; Zubizarreta, J.; Vildosola, S.; Del Alcazar, E. Facial lesions in frontal fibrosing alopecia (FFA): Clinicopathological features in a series of 12 cases. J. Am. Acad. Dermatol. 2015, 73, 987.e1–987.e6. [Google Scholar] [CrossRef]
- Saceda-Corralo, D.; Moreno-Arrones, O.M.; Rubio-Lambraña, M.; Gil-Redondo, R.; Bernárdez, C.; Hermosa-Gelbard, A.; Jaén-Olasolo, P.; Vañó-Galván, S. Trichoscopic features of mild frontal fibrosing alopecia. J. Eur. Acad. Dermatol. Venereol. 2021, 35, e205–e207. [Google Scholar] [CrossRef]
- Dubin, C.; Glickman, J.W.; Del Duca, E.; Chennareddy, S.; Han, J.; Dahabreh, D.; Estrada, Y.D.; Zhang, N.; Kimmel, G.W.; Singer, G.; et al. Scalp and serum profiling of frontal fibrosing alopecia reveals scalp immune and fibrosis dysregulation with no systemic involvement. J. Am. Acad. Dermatol. 2022, 86, 551–562. [Google Scholar] [CrossRef] [PubMed]
n: 52 | Mean |
---|---|
Age (years) | 63.04 (SD 9.69) |
Age of menopause (years) | 50.5 (SD 3.61) |
Age of onset of the alopecia (years) | 58.42 (SD 10.17) |
Duration of the alopecia (months) | 55.58 (SD 37.63) |
Frequencies | |
Menopause | 88.5% (46/52) |
Pruritus | 71.2% (37/52) |
Trichodynia | 23.1% (12/52) |
Occipital involvement | 9.6% (5/52) |
Eyebrow alopecia | 86.5% (45/52) |
Facial papules | 21.2% (11/52) |
FFA severity grade: | |
Grade I | 5.8% (3/52) |
Grade II | 38.5% (20/52) |
Grade III | 36.5% (19/52) |
Grade IV | 11.5% (6/52) |
Grade V | 7.7% (4/52) |
Perifollicular erythema | 84.6% (44/52) |
Follicular hyperkeratosis | 88.5% (46/52) |
N52 | Mean (SD) | ||
---|---|---|---|
Follicular Count | Frontal Hairline (B1) | Healthy Scalp (B2) | p Value |
Total | 5.10 (2.77) | 7.79 (3.87) | <0.001 |
Terminal hairs | 4.25 (2.59) | 6.58 (3.48) | <0.001 |
Intermediate hairs | 0.38 (0.91) | 0.50 (1.16) | 0.479 |
Vellus hairs | 0.46 (0.85) | 0.71 (0.98) | 0.166 |
Anagen hairs | 4.67 (2.90) | 7.35 (3.80) | <0.001 |
Telogen hairs | 0.44 (0.67) | 0.44 (0.78) | 1.000 |
N52 | Frontal Hairline (B1) | Healthy Scalp (B2) | p Value |
---|---|---|---|
Inflammatory infiltrate (yes) | 92.3% (48/52) | 86.5% (45/52) | 0.508 |
Severity | |||
Mild | 35.4% (17/48) | 71.1% (32/45) | 0.013 |
Moderate | 60.4% (29/48) | 26.7% (12/45) | |
Severe | 4.2% (2/48) | 2.2% (1/45) | |
Specific location of the inflammatory infiltrate | |||
Sebaceous gland (yes) | 13.5% (7/52) | 5.8% (3/52) | 0.368 |
Dermis (general) (yes) | 88.5% (46/52) | 71.2% (37/52) | 0.035 |
Interfollicular dermis (yes) | 86.5% (45/52) | 71.2% (37/52) | 0.057 |
Superficial perivascular lymphohistiocytic infiltrate | 86.4% (44/52) | 69.2% (36/52) | 0.039 |
Frontal Hairline (B1) | Healthy Scalp (B2) | p Value | |
---|---|---|---|
Epithelial changes | |||
Corneum stratum changes (including hyperkeratosis, parakeratosis or both) (yes) | 11.5% (6/52) | 24.5% (12/49) | 0.180 |
Epidermal changes (specified below) (yes) | 17.3% (9/52) | 6.1% (3/49) | 0.07 |
Follicular epithelium changes (specified below) (yes) | 70.6% (36/51) | 48.1% (25/52) | 0.012 |
Interface dermatitis lichenoid in the upper part of the hair follicle | 23.5% (12/51) | 15.4% (8/52) | 0.125 |
Vacuolar degeneration basal layer outer root sheath | 64.7% (33/51) | 36.5% (19/52) | 0.001 |
Necrosis of keratinocytes outer root sheath | 43.1% (22/51) | 15.4% (8/52) | 0.001 |
Increased apoptotic activity in outer root sheath (more intense than the physiological grade commonly seen in any biopsy) | 45.1% (23/51) | 19.2% (10/52) | 0.001 |
Infundibular dilatation and infundibular hypergranulosis | 13.7% (7/51) | 7.7% (4/52) | 0.508 |
Fibrous tissular changes | 80.8% (42/52) | 53.8% (28/52) | 0.003 |
Perifollicular fibrosis | 71.2% (37/52) | 30.8% (16/52) | <0.001 |
Interfollicular dermal fibrosis | 53.8% (28/52) | 36.5% (19/52) | 0.122 |
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. |
© 2022 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Porriño-Bustamante, M.L.; Pinedo-Moraleda, F.J.; Fernández-Flores, Á.; Montero-Vílchez, T.; Fernández-Pugnaire, M.A.; Arias-Santiago, S. Frontal Fibrosing Alopecia: A Histopathological Comparison of the Frontal Hairline with Normal-Appearing Scalp. J. Clin. Med. 2022, 11, 4121. https://doi.org/10.3390/jcm11144121
Porriño-Bustamante ML, Pinedo-Moraleda FJ, Fernández-Flores Á, Montero-Vílchez T, Fernández-Pugnaire MA, Arias-Santiago S. Frontal Fibrosing Alopecia: A Histopathological Comparison of the Frontal Hairline with Normal-Appearing Scalp. Journal of Clinical Medicine. 2022; 11(14):4121. https://doi.org/10.3390/jcm11144121
Chicago/Turabian StylePorriño-Bustamante, María Librada, Fernando Javier Pinedo-Moraleda, Ángel Fernández-Flores, Trinidad Montero-Vílchez, María Antonia Fernández-Pugnaire, and Salvador Arias-Santiago. 2022. "Frontal Fibrosing Alopecia: A Histopathological Comparison of the Frontal Hairline with Normal-Appearing Scalp" Journal of Clinical Medicine 11, no. 14: 4121. https://doi.org/10.3390/jcm11144121