Frontal Fibrosing Alopecia and Sunscreen Use: A Cross-sectional Study of Actinic Damage

Authors

  • María Librada Porriño-Bustamante
  • Trinidad Montero-Vílchez Dermatology Department, University Hospital Virgen de las Nieves, Avenida de Madrid, 15, ES-18012, Granada, Spain
  • Fernando Javier Pinedo-Moraleda Pathology Department. University Hospital Fundación Alcorcón, Madrid
  • Ángel Fernández-Flores Pathology Department. University Hospital El Bierzo, León
  • María Antonia Fernández-Pugnaire Dermatology Department. University Hospital San Cecilio, Granada
  • Salvador Arias-Santiago Dermatology Department. University Hospital Virgen de las Nieves, Granada

DOI:

https://doi.org/10.2340/actadv.v102.306

Keywords:

frontal fibrosing alopecia, sunscreens, actinic damage, histopathology, trichoscopy

Abstract

Patients with frontal fibrosing alopecia report higher rates of sunscreen use than control subjects. However, it is not known whether the higher use of sunscreens is a cause or a consequence of the alopecia. A greater use of sunscreens should be associated with a lower incidence of signs of actinic damage. The aim of this study is to assess the presence of actinic damage in patients with frontal fibrosing alopecia. A cross-sectional study was carried out on 101 patients with frontal fibrosing alopecia and 40 control subjects. The presence of actinic damage, in the form of solar lentigines, actinic keratoses, and basal and squamous cell carcinomas, was recorded in both groups, together with sunscreen use. Trichoscopy and skin biopsy were performed on patients. Actinic damage was present more frequently in patients with frontal fibrosing alopecia (69.3%) than in control subjects (50%) (p = 0.031). Patients used sunscreens more frequently than did control subjects (83.2% vs 62.5%, p = 0.008). However, the prevalence of trichoscopic inflammatory signs, peripheral alopecia, and inflammatory infiltrate and sebaceous gland involvement in skin biopsy, were similar in patients who used sunscreens and those who did not use them. In conclusion, patients with frontal fibrosing alopecia had greater actinic damage than did control subjects, and this is hypothesized as a reason for the higher use of sunscreens among patients. Thus, use of sunscreens may not be the trigger for frontal fibrosing alopecia that dermatologists have proposed.

Downloads

Download data is not yet available.

References

Aldoori N, Dobson K, Holden CR, McDonagh AJ, Harries M, Messenger AG. Frontal fibrosing alopecia: possible association with leave-on facial skin care products and sunscreens; a questionnaire study. Br J Dermatol 2016; 175: 762-767.

https://doi.org/10.1111/bjd.14535

Debroy Kidambi A, Dobson K, Holmes S, Carauna D, Del Marmol V, Vujovic A, et al. Frontal fibrosing alopecia in men: an association with facial moisturizers and sunscreens. Br J Dermatol 2017; 177: 260-261.

https://doi.org/10.1111/bjd.15311

Moreno-Arrones OM, Saceda-Corralo D, Rodrigues-Barata AR, Castellanos-González M, Fernández-Pugnaire MA, Grimalt R, et al. Risk factors associated with frontal fibrosing alopecia: a multicentre case-control study. Clin Exp Dermatol 2019; 44: 404-410.

https://doi.org/10.1111/ced.13785

Porriño-Bustamante ML, Fernández-Pugnaire MA, Arias-Santiago S. A cross-sectional study of rosacea and risk factors in women with frontal fibrosing alopecia. Acta Derm Venereol 2019; 99: 1099-1104.

https://doi.org/10.2340/00015555-3286

Robinson G, McMichael A, Wang SQ, Lim HW. Sunscreen and frontal fibrosing alopecia: a review. J Am Acad Dermatol 2020; 82: 723-728.

https://doi.org/10.1016/j.jaad.2019.09.085

Donati A. Frontal fibrosing alopecia and sunscreens: cause or consequence? Br J Dermatol 2016; 175: 675-676.

https://doi.org/10.1111/bjd.14732

Dhana A, Gumedze F, Khumalo NP. Regarding "Frontal fibrosing alopecia: possible association with leave-on facial skincare products and sunscreens; a questionnaire study". Br J Dermatol 2017; 176: 836-837.

https://doi.org/10.1111/bjd.15197

Porriño-Bustamante ML, Fernández-Pugnaire MA, Arias-Santiago S. Frontal fibrosing alopecia: a review. J Clin Med 2021; 10: 1805.

https://doi.org/10.3390/jcm10091805

Ormaechea-Pérez N, López-Pestaña A, Zubizarreta-Salvador J, Jaka-Moreno A, Panés-Rodríguez A, Tuneu-Valls A. Frontal fibrosing alopecia in men: presentations in 12 cases and a review of the literature. Actas Dermosifiliogr 2016; 107: 836-844.

https://doi.org/10.1016/j.ad.2016.07.004

Vañó-Galván S, Molina-Ruiz AM, Serrano-Falcón C, Arias-Santiago S, Rodrigues-Barata AR, Garnacho-Saucedo G, et al. Frontal fibrosing alopecia: a multicenter review of 355 patients. J Am Acad Dermatol 2014; 70: 670-678.

https://doi.org/10.1016/j.jaad.2013.12.003

Dlova NC, Jordaan HF, Skenjane A, Khoza N, Tosti A. Frontal fibrosing alopecia: a clinical review of 20 black patients from South Africa. Br J Dermatol 2013; 169: 939-941.

https://doi.org/10.1111/bjd.12424

MacDonald A, Clark C, Holmes S. Frontal fibrosing alopecia: a review of 60 cases. J Am Acad Dermatol 2012; 67: 955-961.

https://doi.org/10.1016/j.jaad.2011.12.038

Naylor MF, Farmer KC. The case for sunscreens. A review of their use in preventing actinic damage and neoplasia. Arch Dermatol 1997; 133: 1146-1154.

https://doi.org/10.1001/archderm.1997.03890450096012

Hölzle E. Pigmented lesions as a sign of photodamage. Br J Dermatol 1992; 127: 48-50.

https://doi.org/10.1111/j.1365-2133.1992.tb16989.x

Young AR, Claveau J, Rossi AB. Ultraviolet radiation and the skin: photobiology and sunscreen photoprotection. J Am Acad Dermatol 2017; 76: S100-S109.

https://doi.org/10.1016/j.jaad.2016.09.038

Fitzpatrick TB. The validity and practicality of sun-reactive skin types I through VI. Arch Dermatol 1988; 124: 869-871.

https://doi.org/10.1001/archderm.1988.01670060015008

Leecharoen W, Thanomkitti K, Thuangtong R, Varothai S, Triwongwaranat D, Jiamton S, et al. Use of facial care products and frontal fibrosing alopecia: coincidence or true association? J Dermatol 2021; 48: 1557-1563.

https://doi.org/10.1111/1346-8138.16063

Imhof RL, Larkin SC, Cantwell HM, Torgerson RR, Tolkachjov SN. The association of frontal fibrosing alopecia with skin and hair care products: a survey-based case series of 56 patients seen at Mayo Clinic. J Am Acad Dermatol 2020; 84: 532-534.

https://doi.org/10.1016/j.jaad.2020.03.129

Moreno-Arrones OM, Saceda-Corralo D, Rodrigues-Barata AR, Castellanos-González M, Fernández-Pugnaire MA, Grimalt R, et al. Factors influencing frontal fibrosing alopecia severity: a multicentre cross-sectional study. J Eur Acad Dermatol Venereol 2019; 33: e315-e316.

https://doi.org/10.1111/jdv.15590

Pindado-Ortega C, Saceda-Corralo D, Buendía-Castaño D, Fernández-González P, Monero-Arrones Ó, Fonda-Pascual P, et al. Frontal fibrosing alopecia and cutaneous comorbidities: a potential relationship with rosacea. J Am Acad Dermatol 2018; 78: 596-597.

https://doi.org/10.1016/j.jaad.2017.09.004

Callander J, Frost J, Stone N. Ultraviolet filters in hair-care products: a possible link with frontal fibrosing alopecia and lichen planopilaris. Clin Exp Dermatol 2018; 43: 69-70.

https://doi.org/10.1111/ced.13273

Toledo-Pastrana T, Hernández MJ, Camacho Martínez FM. Perifollicular erythema as a trichoscopy sign of progression in frontal fibrosing alopecia. Int J Trichology 2013; 5: 151-153.

https://doi.org/10.4103/0974-7753.125616

Tan KT, Messenger AG. Frontal fibrosing alopecia: clinical presentations and prognosis. Br J Dermatol 2009; 160: 75-79.

https://doi.org/10.1111/j.1365-2133.2008.08861.x

Saceda-Corralo D, Pindado-Ortega C, Moreno-Arrones OM, Ortega-Quijano D, Fernández-Nieto D, Jiménez-Cauhe J, et al. Association of inflammation with progression of hair loss in women with frontal fibrosing alopecia. JAMA Dermatol 2020; 156: 700-702.

https://doi.org/10.1001/jamadermatol.2020.0359

Pirmez R, Duque-Estrada B, Abraham LS, Pinto GM, de Farias DC, Kelly Y, et al. It's not all traction: the pseudo 'fringe sign' in frontal fibrosing alopecia. Br J Dermatol 2015; 173: 1336-1338.

https://doi.org/10.1111/bjd.14005

Katoulis AC, Damaskou V, Diamanti K, Pouliakis A, Mortaki D, Zacharatou A, et al. Eyebrow involvement in frontal fibrosing alopecia: a clinicopathologic cohort study for the reversibility of hair loss. J Am Acad Dermatol 2020; 82: 755-757.

https://doi.org/10.1016/j.jaad.2019.09.002

Miteva M, Sabiq S. A new histologic pattern in 6 biopsies from early frontal fibrosing alopecia. Am J Dermatopathol 2019; 41: 118-121.

https://doi.org/10.1097/DAD.0000000000001247

Moreno-Ramírez D, Ferrándiz L, Camacho FM. [Diagnostic and therapeutic assessment of frontal fibrosing alopecia]. Actas Dermosifiliogr 2007; 98: 594-602.

https://doi.org/10.1016/S0001-7310(07)70144-8

Downloads

Published

2022-08-11

How to Cite

Porriño-Bustamante, M. L., Montero-Vílchez, T., Pinedo-Moraleda, F. J., Fernández-Flores, Ángel, Fernández-Pugnaire, M. A., & Arias-Santiago, S. (2022). Frontal Fibrosing Alopecia and Sunscreen Use: A Cross-sectional Study of Actinic Damage. Acta Dermato-Venereologica, 102, adv00757. https://doi.org/10.2340/actadv.v102.306

Issue

Section

Articles

Categories