Janus kinase inhibition for the treatment of refractory frontal fibrosing alopecia: A case series and review of the literature
Abstract
FFA: Frontal fibrosing alopecia FFASI: frontal fibrosing alopecia severity index IFN: interferon IL: interleukin JAK: Janus kinase LPP: lichen planopilaris LPPAI: lichen planopilaris activity index INTRODUCTION Frontal fibrosing alopecia (FFA) is a clinical variant of lichen planopilaris (LPP) characterized by slow, progressive, perifollicular inflammation with complete loss of hair and follicular ostia that primarily impacts the frontotemporal hairline. FFA is uncommon and impacts postmenopausal women disproportionately, although there are reports of affected men and children. The etiology of FFA is unclear, with hormonal factors, autoimmunity, genetic susceptibility, immune dysregulation, and environmental exposures hypothesized to play a role. In studies, the severity of LPP is often quantified on a scale of 1 (less severe) to 10 (more severe) using the lichen planopilaris activity index (LPPAI); alternatively, in LPP with FFA, the more specific frontal fibrosing alopecia severity index (FFASI) that accounts for hairline recession, inflammatory band, nonscalp loss, and associated features—quantified from 1 (less severe) to 100 (more severe)—is used. The disease can be debilitating, and largely because of a poor understanding of disease pathogenesis, currently, there is a lack of standardized evidencebased therapeutics for patients with FFA. Many recommendations are derived from findings in small case series or reports. Therapeutic options are often limited, responses to…
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