Acta Dermato-Venereologica 99-12CompleteContent | Page 13

1099 CLINICAL REPORT A Cross-sectional Study of Rosacea and Risk Factors in Women with Frontal Fibrosing Alopecia María Librada PORRIÑO-BUSTAMANTE 1,2 , María Antonia FERNÁNDEZ-PUGNAIRE 3 and Salvador ARIAS-SANTIAGO 4,5 Department of Dermatology, University Hospital La Zarzuela, Madrid, 2 Faculty of Medicine, University of Granada, 3 Department of Dermatology, University Hospital San Cecilio, 4 Department of Dermatology, University Hospital Virgen de las Nieves, and 5 Institute of Biosanitary Investigation ibs. Granada, Spain 1 Frontal fibrosing alopecia has been related to some auto­immune diseases, but the association with rosa- cea is not clear. The objective of this study was to ana- lyse the prevalence of rosacea in a group of patients with frontal fibrosing alopecia. A cross-sectional stu- dy, including 99 women with frontal fibrosing alope- cia and 40 controls, was performed, in which clinical, dermoscopic and hormonal data were analysed. Wo- men with frontal fibrosing alopecia presented a higher prevalence of rosacea than the controls did (61.6% vs. 30%, p  = 0.001), especially those with severe gra- des of alopecia (77.8% in grade V vs. 33.3% in gra- de I, p  =  0.02). Binary logistic multivariate analysis showed that perifollicular erythema (odds ratio (OR) 8.5; 95% confidence interval (95% CI) 1.73–42.30), higher body mass index (OR 1.16; 95% CI 1.01– 1.34) and lower progesterone levels (OR 0.15; 95% CI 0.028–0.89) were associated with a higher risk of rosacea in patients with frontal fibrosing alopecia. In conclusion, patients with frontal fibrosing alopecia presented a higher prevalence of rosacea than did con- trols. Perifollicular erythema, higher body mass index and lower progesterone levels were associated with a higher risk of rosacea in the group with frontal fibros- ing alopecia. Key words: frontal fibrosing alopecia; scarring alopecia; cicatri- cial alopecia; rosacea; hormones; comorbidity. Accepted Aug 12, 2019; E-published Aug 13, 2019 Acta Derm Venereol 2019; 99: 1099–1104. Corr: M ª Librada Porriño-Bustamante, Department of Dermatology, University Hospital La Zarzuela, Calle de Pleyades, 25, ES-28023 Madrid, Spain. E-mail: [email protected] F rontal fibrosing alopecia (FFA) is a lymphocytic scar- ring alopecia characterized by progressive recession of the frontal and temporoparietal hairline with loss of follicular openings. The eyebrows are often affected, and sometimes also the eyelashes and body hair (1). Typical dermoscopic findings include perifollicular erythema and hyperkeratosis (2). Lonely hair sign occurs in some patients (3). Despite the initial description of FFA in postmenopau- sal women, increasing number of cases in premenopausal women have been described (4). Moreover, some men with FFA and familial cases have also been reported (2). SIGNIFICANCE The association between frontal fibrosing alopecia and ro- sacea is not clear. In this cross-sectional study, including 99 women with frontal fibrosing alopecia and 40 controls, wo- men with frontal fibrosing alopecia presented a higher pre- valence of rosacea than the controls did (61.6% vs. 30%), especially those with severe grades of alopecia (77.8% in grade V vs. 33.3% in grade I). Moreover, perifollicular ery­ thema, higher body mass index and lower progesterone levels were associated with a higher risk of rosacea in the group with frontal fibrosing alopecia. The pathogenesis of this disease is not well known and autoimmunity, genetic, hormonal, and environmental factors may play a role. Lichen pigmentosus, discoid lupus or vitiligo have been associated with FFA (5–7). Recently, a cross-sectional study without a control group found that 34% of patients with FFA presented rosacea. In this study erythematotelangiectatic rosacea was the most frequent subtype, followed by papulopustular rosacea (8). Rosacea is an inflammatory skin condition charac- terized by recurrent or persistent episodes of centrofa- cial erythema (9). Rosacea is more frequent in women (female: male ratio 2–3:1), typically aged between 30 and 50 years, and is considerably more common in light-skinned people. The lesions predominate on the cheeks and chin in women, and on the nose in men. The National Rosacea Society (NRS) Expert Committee recognizes 4 subtypes, which frequently overlap (i.e. erythematotelangiectatic, inflammatory papulopustular, phymatous and ocular rosacea) (10, 11). Moreover, a single variant, namely granulomatous or lupoid rosacea, is also recognized (10). This classification was proposed in 2002 and has been used worldwide to compare data about rosacea, although recently the NRS has proposed a new classification based on phenotypes (12). The association between FFA and rosacea is not clear, although rosacea-like lesions have been reported on the cheeks in patients with FFA (i.e. perifollicular erythema, sometimes with follicular keratosis, such as keratosis pilaris-like papules) (13, 14). The objectives of this study were to analyse the preva- lence of rosacea in a group of women with FFA compared with a control group, and to explore associated factors. This is an open access article under the CC BY-NC license. www.medicaljournals.se/acta Journal Compilation © 2019 Acta Dermato-Venereologica. doi: 10.2340/00015555-3286 Acta Derm Venereol 2019; 99: 1099–1104