Moisturizers, facial soap associated with frontal fibrosing alopecia in Brazilian cohort

Results of a case-control study in Brazil indicated that frontal fibrosing alopecia was associated with use of ordinary facial soap and moisturizers.

“Frontal fibrosing alopecia (FFA) is a chronic cicatricial alopecia with unknown etiology and a worldwide rising incidence,” Paulo Müller Ramos, MD, PhD, of Universidade Estadual Paulista in Botucatu, Brazil, and colleagues wrote.

The researchers assessed associations between FFA and demographic and exposure factors in a multiracial population of Brazilian citizens.

The analysis included 451 patients with FFA and an equal number of sex-matched controls accrued at 11 referral centers in the country. Study participants were asked to complete a survey that included questions about demographics, environmental exposure, diet, hormonal factors, allergies, and hair and skin care, the study said.

The study population was 96% women, with 9% of the cohort having a familial occurrence of FFA. Mean age at onset of FFA was 47 years, which the researchers noted was around the age of menopause for many of the women.

In an analysis that adjusted for sex, age, menopause and skin color, an association was observed between FFA and hair straightening with formalin (OR = 3.18; 95% CI, 2.11-4.80). In addition, FFA also carried associations with use of ordinary non-dermatologic facial soap (OR = 2.09; 95% CI, 1.50-2.90) and facial moisturizer (OR = 1.99; 95% CI, 1.39-2.86).

There was a higher prevalence of thyroid disorders (P = .002) and rosacea (P = .001) in those with FFA, according to the findings.

Negative associations were reported between FFA and smoking (OR = 0.33; 95% CI, 0.21-0.51) and use of anti-residue/clarifying shampoo (OR = 0.35; 95% CI, 0.19-0.67).

No significant association was observed between FFA and sunscreen use.

Other findings showed that FFA presented earlier in individuals with a first-degree familial occurrence (P = .007). However, neither female sex nor darker skin color was associated with age of FFA onset.

The researchers said that recall bias was the main limitation of the study.

“The association with moisturizers, ordinary facial soap and hair straightening with formalin and the negative association with anti-residue/clarifying shampoo reinforce the possibility of an exogenous particle triggering FFA,” they wrote.