17043 Frontal fibrosing alopecia severity score: A 3-year prospective study

The Frontal Fibrosing Alopecia Severity Score (FFASS) was described to classify frontal fibrosing alopecia (FFA) patients. Its prospective use can help us to understand better the relationship between inflammation and hairline recession. We conducted a three-year prospective study. All patients started the same treatment in the first visit (oral dutasteride 0.5 mg 3 times a week, topical clobetasol twice weekly and triamcinolone injections 4-8 mg/mL). Patients were assessed with the FFASS every 6 months. To improve the accuracy of the inflammation score, perifollicular scaling and erythema were evaluated by trichoscopy (grade 2: trichoscopic and clinically present; grade 1: only present in trichoscopy). A total of 57 women were included into the study. Their mean age of 62.4 years and 47 (82.5%) had reached their menopause. Mean follow-up was 45.3 months (range 30-48 months). Mean FFASS score in the first visit was 13.2 (extent score 12.0 and inflammation score 1.2). Thirty-four patients (59.6%) had no hairline recession. Of them, 26 (76.5%) had also an improvement in inflammatory signs, but 8 patients (23.5%) still presented inflammation during follow-up. In 23 patients (40.4%) the hairline kept receding despite treatment. The inflammation persisted in 16 patients (69.6%), but 7 patients (30.4%) had no inflammatory signs or they improved. Interestingly, inflammatory signs of the disease were not always correlated to progression of the alopecia. The concomitant medical treatment is a limitation of the study. In conclusion, inflammation is a relevant sign in FFA, but it does not always entail worsening of the alopecia.