The jury is still out on the cause of frontal fibrosing alopecia but the increasing worldwide incidence over the last 20 years suggests it is a new disease involving an environmental factor.
Dermatologist and president of the Institute of Trichologists in London Professor Andrew Messenger told the ACD ASM that – controversially – sunscreens were the top suspect.
He said a survey comparing lifestyle and exposures of women with and without frontal fibrosing alopecia found sunscreen use was significantly more common in affected women.
Use of other leave-on facial products including cleansers, toners, foundations and moisturisers was not significantly different between the two groups of women.
And a recent Australian study supported those earlier findings, he said.
Professor Messenger said another recent study had also confirmed the ubiquity of titanium dioxide along the hair shafts of people with and without frontal fibrosing alopecia.
While the time course of the disease and predominant pattern of hair loss supported the sunscreen theory, there were other factors arguing against it.
For example, hair loss in frontal fibrosing alopecia also occurred on the limbs and there could be other “confounding factors of affluence” at play.
Professor Messenger told the limbic a reasonable sized series had reported frontal fibrosing alopecia (FFA) in black Africans.
“One of the arguments against sunscreens [in FFA] is that Africans don’t use sunscreens but some of them do.”
He said about 14% of black skinned Africans and 22% of Indians were using sunscreens.