Clinicopathological features and treatment outcomes of fibrosing alopecia in a pattern distribution: a multicentre cohort study

Abstract

BACKGROUND: Fibrosing alopecia in a pattern distribution (FAPD) is a lymphocytic primary cicatricial alopecia first described in 2000. However, to date, the FAPD literature remains sparse. OBJECTIVES: To identify clinicopathological features and treatment outcomes of FAPD in a large multicentre cohort. METHODS: Patients who had biopsy-proven FAPD were selected from nine specialist hair clinics and were reviewed retrospectively to evaluate the clinical pattern of hair loss, trichoscopic and histopathological features, and response to treatment. RESULTS: Of 110 patients, with a mean age of onset of 52.5 (SD 14.8) years, 94 (85.5%) were women. The most common trichoscopic findings were loss of follicular ostia (97.2%, 103/106) and anisotrichia (97%, 84/87). Histopathological examination revealed perifollicular lymphocytic infiltration in 96.1% (99/103) and concentric lamellar fibrosis in 97% (92/95). After a median duration of treatment of 24 [interquartile range (IQR) 13-50] months, there was stabilization in hair density [median Sinclair grade 3.0 (IQR 3.0-4.0) pretreatment vs. 3.0 (IQR 2.0-4.0) post-treatment, P = 0.62]. Out of the 42 patients who received treatment for ≥ 12 months, 23 achieved stabilization and 16 demonstrated improvement in hair density. CONCLUSIONS: Limitations of the study include its retrospective design and disparate treatments. FAPD may be prone to misdiagnosis because of overlapping clinicopathological features with androgenetic alopecia. A combination of anti-inflammatory (for example, topical corticosteroids) and hair growth-promoting agents (for example, topical or low-dose oral minoxidil) can stabilize the condition or even promote hair regrowth.