Oral contraceptive pill usage may be associated with frontal fibrosing alopecia

Key takeaways:

• Women with a history of oral contraceptive pill usage were 1.9 times more at risk for frontal fibrosing alopecia.
• Women with no history of oral contraceptive pill usage were unaffected.

Women who use contraceptive pills may be at a higher risk for frontal fibrosing alopecia, according to a study.

“[Frontal fibrosing alopecia (FFA)] incidence has shown a continuous increase since its initial documentation in 1994, provoking speculation regarding the role of changing environmental factors in its pathogenesis,” Tuntas Rayinda, MD, MSc, PhD, dermatologist and venereologist at RSUP Dr. Sardjito and lecturer at Gadjah Mada University in Indonesia, and colleagues wrote in a study published in JAMA Dermatology.

According to the authors, a previous study of theirs identified risk loci in multiple genes that may cause FFA in women. The missense variant, CYP1B1, has been shown to help protect against FFA; however, the use of oral contraceptive pills (OCPs) could modulate this effect.

In this study, Rayinda and colleagues investigated whether OCPs mitigate the protective effect of CYP1B1 on FFA risk. The researchers collected data on 489 women with FFA (mean age, 65.8 years), 75.7% of which had a history of OCP use. These women were matched with 34,254 controls (mean age, 65 years), 91% of which reported previous OCP use.

Results showed that the presence of the risk allele in CYP1B1 was associated with FFA risk (OR = 1.64; 95% CI, 1.35-1.99). However, after stratifying the cohort into women who used OCPs and those who did not, results showed that this association was only found in women with a history of OCP use.

More specifically, women who previously used OCPs were 1.9 times (95% CI, 1.5-2.4) more likely to experience the association, whereas women without a history of OCPs were not (OR = 1.16; 95% CI, 0.82-1.64).

Additionally, a full gene-environment interaction model demonstrated a significant additive statistical interaction between CYP1B1, FFA risk and a history of OCP use (OR = 1.63; 95% CI, 1.07-2.46).

“The findings suggest that OCP use may represent an environmental exposure that is associated with increase FFA risk,” the authors concluded. “This further supports the theory that aberration in hormone levels and xenobiotic metabolism contribute to FFA pathogenesis.”