Abstract
Background
Since its first description in 1994 frontal fibrosing alopecia (FFA) has become increasingly common, suggesting that environmental factors are involved in the aetiology.
Objective
To identify possible causative environmental factors in frontal fibrosing alopecia.
Methods
A questionnaire enquiring about exposure to a wide range of lifestyle, social and medical factors was completed by 105 women with FFA and 100 age and sex-matched control subjects. A sub-cohort of women with FFA was patch-tested to an extended British standard series of allergens.
Results
The use of sunscreens was significantly greater in the FFA group compared to controls. FFA subjects also showed a trend towards more frequent use of facial moisturisers and foundations but, compared to controls, the difference in frequencies just failed to reach statistical significance. The frequency of hair shampooing, oral contraceptive use, hair colouring and facial hair removal were significantly lower in the FFA group than in controls. Thyroid disease was more common in FFA subjects than controls and there was a high frequency of positive patch tests in women with FFA, mainly to fragrances.
Conclusions
Our findings suggest an association between FFA and the use of facial skin care products. The high frequency of sunscreen use in patients with FFA, and the fact that many facial skin care products now contain sunscreens, raises the possibility of a causative role for sunscreen chemicals. The high frequency of positive patch tests in women with FFA and the association with thyroid disease may indicate a predisposition to immune-mediated disease.
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