Evaluation of trigger environmental factors and the effect of the disease on the quality of life in patients with frontal fibrosing alopeci̇a

Since its first description in 1994, frontal fibrosing alopecia (FFA) has become increasingly common, suggesting that environmental factors are involved in the aetiology. The primary aim of this study was to investigate possible causative environmental factors in FFA. In addition, defining the clinical and sociodemographic characteristics of the patients and identifying the psychological factors and İnternalized stigma were other aims of the study. 56 FFA patients and age and sex matched control subjects who applied to Akdeniz University, Faculty of Medicine, Dermatology and Venereology Department have been enrolled in this study. Sociodemographic characteristics of the patients (age, gender, family history, smoking and alcohol use, menopause age, FFA onset age), comorbidities, clinical findings (FFASI, facial papules, body hair involvement, eyebrow and eyelash involvement), hair and face dermoscopy findings (perifollicular erythema, perifollicular hyperkeratosis, vellus hair involvement, demodicosis), clinical symptoms (hyperhidrosis, trichodynia, pruritus) were recorded on the day of admission. At the same time, the Hospital Anxiety and Depression Scale (HADS), Internalized Stigma Scale (ISS), FFA Etiological Factors Questionnaire questioning exposure to a wide variety of lifestyle, social and medical factors were administered. The mean age of FFA patients was 59,59 ± 11,07, the mean age of FFA onset was 53,75 ± 10,19, and 85,7% of the patients were postmenopausal women. Although early menopause (40-45 years) (%29) and HRT (%28,6) had a higher prevalence in the FFA group, it was not statistically significant. Use of sunscreen cream (p = 0,001), moisturizer (p = 0,007), facial cleansing tonic (p = 0,03), shampoo (p = 0,001) and hair care oils (p = 0,003), use of bleach ( p = 0,007) and botox administration (p = 0,014) were statistically significantly higher in FFA patients compared to controls. The use of soap for hair (p = 0,01) and the use of a turban were significantly higher in the control group than in the FFA group (p = 0,02). Eyebrow involvement was detected in 75% of the patients, while pigmented macules (%64,3) were the most common facial lesions. Hypothyroidism and hypertension were significantly higher in FFA patients than controls. A significant correlation was found between complete eyebrow loss, arm, leg and axillary hair involvement, perifollicular hyperkeratosis, perifollicular erythema and FFASI scores. In FFA patients, the total mean ISS score was 56,98 ± 9,2, HADS was 12,8 ± 8,4 (depression 5,6 ± 4,3, anxiety 7,2 ± 4,1) and a significant relationship was found between eyebrow loss and HADS. Our findings show that in FFA patients, systemic diseases such as hypothyroidism, hypertension, sunscreen creams and moisturizers, especially cosmetic procedures such as tonic, shampoo and care oils, bleaching procedures and botox application can play a role in the etiology of the disease. On the other hand, the use of turban, which has a protective effect against UV, and the use of soap may play a protective role from FFA. FFA disease should be evaluated not only as a hair disease, but also with body hair involvement and accompanying facial lesions and accompanying comorbidities. For the most common accompanying thyroid disease, we think that FFA patients should be tested at their first admission. In addition, our study draws attention to the psychological and social effects of the disease, the internalized stigmatization levels of the patients and the factors affecting them. Key Words: Frontal fibrosing alopecia, environmental factors, internalized stigma, depression, anxiety