Frontal Fibrosing Alopecia Treatment Largely Similar in Black, White Patients

Initial treatment patterns for frontal fibrosing alopecia (FFA) were largely similar between Black and White patients, and higher tetracycline use among Black patients appeared to be associated with concurrent scarring alopecia, according to a retrospective cohort study presented as a poster at the 2026 Skin of Color Update in New York, New York.¹

FFA is a progressive cicatricial alopecia, a scarring hair loss disorder, characterized by symmetric, band-like recession of the frontotemporal hairline that may also involve the eyebrows. In a 10-year single-center retrospective cohort study published in the Journal of the American Academy of Dermatology, several of the same Penn investigators found that inflammatory dermoscopic features, including background and perifollicular erythema, were less commonly documented in Black patients with FFA.² Whether initial treatment also differs by race has remained unclear, according to the investigators from the Department of Dermatology at the Perelman School of Medicine, University of Pennsylvania.¹

Frontal Fibrosing Alopecia Study Design and Patient Cohort

Researchers reviewed an established cohort of adults with FFA seen within the University of Pennsylvania Health System from January 1, 2014, to August 22, 2025. Cases were identified using the ICD-10 code L66.12 and confirmed by individual chart review. The cohort included 142 patients: 71 Black patients and 71 White patients matched 1:1 by age and sex.

Researchers compared treatments documented at each patient’s initial visit by race using 2-sided Fisher exact tests, which were also used to assess the association between tetracycline use and concurrent scarring alopecia among Black patients.

Initial Frontal Fibrosing Alopecia Treatment by Race

Initial topical, intralesional, and systemic treatment patterns were generally similar between groups, the investigators reported. Any topical therapy was documented in 77.5% of Black patients and 74.6% of White patients, and any systemic therapy in 47.9% and 46.5%, respectively. Topical corticosteroids were used in 64.8% and 63.4% of patients, and intralesional corticosteroid injections in 25.4% and 31.0%.

Other initial therapies included topical calcineurin inhibitors (14.1% vs 11.3%), topical minoxidil (15.5% vs 12.7%), hydroxychloroquine (9.9% vs 14.1%), finasteride or dutasteride (7.0% vs 18.3%), and oral minoxidil (5.6% vs 7.0%). P values were not reported for these comparisons. No treatment was documented for 8.5% of Black patients and 2.8% of White patients.

Tetracycline-class antibiotics (doxycycline or minocycline) were prescribed at the initial visit to 33.8% of Black patients (24/71) compared with 14.1% of White patients (10/71; P = .0099).

Concurrent Scarring Alopecia and Tetracycline Use in Black Patients

Among Black patients, 42.3% (30/71) had a concurrent scarring alopecia; concurrent scarring alopecia was reported only for Black patients. Tetracycline use was higher in this subgroup than among Black patients without a concurrent scarring alopecia (50.0% vs 22.0%; P = .0217). In a sensitivity analysis excluding Black patients with concurrent scarring alopecia, the difference in tetracycline use between Black and White patients was no longer statistically significant (22.0% vs 14.1%; P = .306).

Based on these findings, the investigators concluded that initial FFA treatment patterns were largely similar by race and that higher tetracycline use among Black patients appeared to be associated with concurrent scarring alopecia. Treatment differences may reflect overlapping cicatricial alopecias rather than race itself, they wrote, highlighting the importance of recognizing concurrent scarring diagnoses in diverse patients with FFA.

References

1. Adhanom R, Ansah MA, Alomary SA, et al. Racial differences in initial treatment patterns for frontal fibrosing alopecia (FFA): a retrospective cohort study. Poster presented at: Skin of Color Update 2026; October 9-11, 2026; New York, NY. Poster ED-25.
2. Alomary SA, Baker NJ, Alkiswani H, Schell N, Ogunleye T, Taylor SC. Racial differences in frontal fibrosing alopecia: a 10-year single-center retrospective cohort study. J Am Acad Dermatol. Published online July 8, 2026. doi:10.1016/j.jaad.2026.07.013