Application of the new clinical guidelines in frontal fibrosing alopecia of the male

Background: Frontal fibrosing alopecia (FFA) is a cicatricial alopecia of growing incidence that primarily affects postmenopausal women. However, males represent 3-5% of AFF cases and have distinct clinical characteristics. The objective of the study was to apply the new clinical guidelines of the International FFA Cooperative Group and discover possible shortcomings in their use in men. The guidelines were applied to a series of 18 men with a clinical and histological diagnosis of FFA. We evaluated the diagnostic criteria and measure degree of recession. The hairline recession pattern was classified as linear (type I), diffuse (type II), or pseudo fringe sign pattern (type III). To complete the degree of extension, the ALODEX III scale was used. The absence of vellus hairs (72%) and frontal perifollicular erythema (67%) were the most prevalent diagnostic criteria. Type 1 recession pattern was observed in 72% of patients. Beard was affected in 56% of the patients, being sideburns the most frequently affected area (78%) followed by the mandibular ramus (56%). The median frontal recession was 7.7 cm (range 7 – 8.5 cm). The ALODEX III scale showed involvement of the most lateral hairline, not included in the standardized measures, in 40-50% of patients. In conclusion, the evaluation of the beard and the early involvement of the sideburns may be underrepresented within the actual diagnostic criteria.