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Frontal Fibrosing Alopecia Risk Factors

Frontal fibrosing alopecia (FFA) is an increasingly common cause of hair loss not just in North America but in many parts of the world. It is a type of scarring alopecia characterized by frontotemporal hair loss, as well as hair loss of the eyebrows in many cases. As it is a type of scarring hair loss, the hair loss is permanent and our treatments are focused on preventing disease progression.

There is no definitive cause for this hair disorder but many speculate that exogenous products may be causing this condition. One of the possible culprits may be sunscreens as several case-control studies suggest this may be a factor. A recent study published in the Journal of the American Academy of Dermatology found possible associations of frontal fibrosing alopecia with long-term use of facial moisturizers, ordinary (non-dermatologic) soap, and formalin hair straighteners. Interestingly, sunscreen use was not associated with FFA in this study, and smoking and anti-residue shampoos were found to be protective.

Although there is no absolute consensus on whether or not sunscreens are a culprit, this study does continue to support the possibility that topical products may be responsible for eliciting an inflammatory reaction causing hair loss. It might help explain why anti-residue/clarifying shampoos may be protective against this condition.

More research will need to be done to clarify the impact of exogenous agents on this type of scarring alopecia.

References

Cranwell WC, Sinclair R. Sunscreen and facial skincare products in frontal fibrosing alopecia: a case-control study.Br J Dermatol. 2019; 180: 943-944

Risk factors for frontal fibrosing alopecia: A case-control study in a multiracial population.Ramos PM, Anzai A, Duque-Estrada B, Farias DC, Melo DF, Mulinari-Brenner F, Pinto GM, Abraham LS, Santos LDN, Pirmez R, Miot HA.J Am Acad Dermatol. 2021 Mar;84(3):712-718. doi: 10.1016/j.jaad.2020.08.076. Epub 2020 Aug 22.PMID: 32835739