A multicentre cohort study of the clinicopathological features and treatment outcomes of fibrosing alopecia in a pattern distribution

Objective To identify clinicopathological features and treatment outcomes of diagnosed FAPD in multiple specialized hair clinics. Material and methods Patients with biopsy-proven FAPD from nine dermatology centers were reviewed retrospectively to evaluate the clinical pattern of hair loss, trichoscopic and histopathological features as well as response to treatment. Results Of 110 patients, 85.5% were female, with a mean age of onset of 52.5 years. The most common trichoscopic findings were loss of follicular ostia (97.2%) and anisotrichia (96.6%). Histopathological examination revealed perifollicular lymphocytic infiltration in 96.1% and concentric lamellar fibrosis in 96.8% of cases. After a median (IQR) duration of treatment of 36 (30) months, there was stabilization in hair (median Sinclair grade 3.0 [1.5] pre-treatment vs 3.0 [2.0] post-treatment, p = 0.763). Out of the 31 patients, 15 had stabilization and 14 had improvement. Limitations Retrospective design and disparate treatments. Conclusion FAPD may be prone to misdiagnosis due to overlapping clinicopathological features with androgenetic alopecia. A combination of anti-inflammatory (e.g., topical corticosteroids) and hair growth-promoting agents (e.g., topical or low-dose oral minoxidil) can stabilize the condition or even promote hair regrowth.