Frontal Fibrosing Alopecia Negatively Impacts HRQOL, Say Patients

Over half of the patients (53%) included in the study indicated that frontal fibrosing alopecia had a negative impact on their health-related quality of life (HRQOL).

The majority of patients with frontal fibrosing alopecia (FFA) face challenges with health related quality of life (HRQOL), find new study results, which found that the implications are more pronounced for patients with other sites of involvement.

Over half of the 49 patients (53%) included in the study indicated that FFA had a negative impact on their HRQOL, which was measured with the Dermatology Life Quality Index (DLQI) and the 36-Item Short Form Survey (SF-36). In the majority of patients who reported impacted HRQOL, the impact fell in the low effect group.

Results showed that DLQI scores, which ranged between 0 and 11, were significantly higher in patients with temporal, frontal, or flexural involvement. According to the researchers, these factors are associated with poorer prognosis and ineffectiveness of treatment.

The group also found associations between DLQI scores and the presence of facial papules. Meanwhile, neither SF-36 nor the mental health component of SF-36 had associations with the presence of facial papules.

“This can be attributed to the symmetric involvement, slow progression, and possibility of covering affected areas in mild cases. Compulsory hijab can be another factor in lowering the effect of disease on HRQOL, because female patients can cover the affected areas at the outdoor, which is common and does not seem odd,” wrote the researchers, whose study cohort included those visiting the Razi Skin Hospital in Tehran. They added, “Using FFASI helped us to improve the study validation.”

The Frontal Fibrosing Alopecia Severity Score Index (FFASI) was dermatologist administered and used to assess disease severity, with scores ranging between 14 and 66 out of 100. There were no significant associations observed between FFASI scores or duration of disease and HRQOL.

“To our knowledge, this is the first study of the concomitant use of three indices to illustrate the relationship between different aspects of FFA, like disease severity, site of involvement, and various co-variants with patients’ HRQOL,” wrote the researchers. “However, the delineation of quality of life can only be described by patients; therefore, a subjective element is strongly present. The possible drawback of the present study is the limited number of patients, which can be attributed to the disease rareness. Finally, having a control group of healthy people could ameliorate the quality of the study.”

The 49 patients were largely female (98%) and the length of being diagnosed ranged from 6 months to 5 years. Other findings included a reverse association between the patient’s age and physical function and a higher score for single patients when it came to physical function, general, and vitality.

The researchers found no correlations between the DLQI, SF-36, or mental health component of SF-36 with factors such as age, duration of diagnosis, gender, marriage status, level of education, receiving treatment, employment status, and FFASI score.


Varghaei A, Rostami A, Yarmohamadi M, Mahmoudi H, Balighi K, Daneshpazhooh M. Assessment of health-related quality of life in patients with frontal fibrosing alopecia. J Cosmet Dermatol. Published online June 27, 2022. doi:10.1111/jocd.15183

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