Christos Tziotzios

Finasteride is of uncertain utility in treating frontal fibrosing alopecia.

To the Editor: We were interested to read the report by Danesh and Murase on the potential of finasteride as ‘‘a safe and alternative’’ treatment option for frontal fibrosing alopecia in the Journal’s Therapeutic Pearls section. We note that their conclusions were based on 2 reports by Va~ n o-Galv an et al and Moreno-Ram ırez et al and we wish to highlight the following: Danesh and Murase state that ‘‘2.5 to 5 mg/d in a study involving 102 patients showed improvement in 48 (47%) and stabilization in 54 (53%) patients.’’ However, Danesh and Murase have omitted the detail that 74.8% of the 111 people treated with antiandrogens (dutasteride and finasteride) in this retrospective study were treated concurrently with topical minoxidil. Of the 28 of 111 subjects who only received a 5 -reductase inhibitor, 9 reportedly improved and 19 stabilized. Va~ n o-Galv an et al have clarified that ‘‘in cases of improvement the regrowth of hair was minimal and always located at the hairline.’’ Also, these authors have stated that ‘‘response to antiandrogens was more frequent if androgenetic alopecia was present.’’ Moreover, Va~ n o-Galv an et al accepted that spontaneous stabilization could be possible, although the reported frequency was low in their case series (6% of the 79 untreated cases). To this end, it is worth emphasizing that the mean follow-up time in this study was 2.1 years (ranging from 0.4-19 years). Reference is made to a report by MorenoRam ırez et al according to which ‘‘a combination strategy using finasteride (2.5 mg/d) and minoxidil (2% twice daily) in 8 patients halted progression of disease in 4 (50%) patients after 12 to 18 months.’’ Danesh and Murase omitted reference to an additional statement made by Moreno-Ram ırez et al: ‘‘the improvement obtained was related to the improvement in the level of the associated androgenetic alopecia.’’ Danesh and Murase correctly highlight the side effects associated with finasteride but we would like to add that in a report from the United Kingdom Medicines and Healthcare Products Regulatory Agency on the risk of male breast cancer with finasteride, the data mentioned 4 cases of female breast cancer associated with off-license use of finasteride. Although there is lack of documentation on the doses of finasteride, 3 cases were treated with the 1 mg of Propecia brand (1 with 5 mg of Proscar brand [Proscar and Propecia are manufactured by Merck, Kenilworth, NJ]).

Familial frontal fibrosing alopecia

To the Editor: We read the article by Chan and colleagues on frontal fibrosing alopecia (FFA) with interest. The authors report that, to their knowledge, ‘‘to date, only 1 other case of familial FFA has been reported.’’ We would like to bring to the authors’ attention an article published by Dlova and colleagues reporting 4 previously unreported and 3 previously reported families with frontal fibrosing alopecia. Moreover, 7 further families with highly consistent clinical features of FFA are currently under our care and 5 more have been referred to us for genetic exploration. The largest pedigree involves 5 individuals across 2 generations and the observed inheritance pattern in all cases is in keeping with probable autosomal dominant transmission with reduced penetrance, implicating an unexplored genetic element to this intriguing condition. Additional genomic studies therefore also seem warranted. Twin concordance studies have not been reported to date, although we have recently initiated this in the United Kingdom. Familial forms of lichen planus and Lassueur-Graham-LittlePiccardi syndrome have also previously been described. If one considers FFA to represent a generalized fibrotic cutaneous disorder, sharing similarities in immunopathogenesis with alopecia areata but at a different anatomic level, then dissecting the molecular basis of this intriguing condition could be worthwhile. Such an approach would build on and expand findings such as those reported by Chan and colleagues and may well transform the field in cicatricial alopecia therapeutics in a similar manner to the advances seen with alopecia areata following its successful molecular genetic characterization.

Clinical features and WNT10A mutations in seven unrelated cases of Schöpf-Schulz-Passarge syndrome

Schöpf‐Schulz‐Passarge syndrome (SSPS) is an autosomal recessive form of ectodermal dysplasia resulting from mutations in WNT10A.

Congenital Anonychia and Uncombable Hair Syndrome: Coinheritance of Homozygous Mutations in RSPO4 and PADI3

Citing this paper Please note that where the full-text provided on Kings Research Portal is the Author Accepted Manuscript or Post-Print version this may differ from the final Published version. If citing, it is advised that you check and use the publishers definitive version for pagination, volume/issue, and date of publication details. And where the final published version is provided on the Research Portal, if citing you are again advised to check the publishers website for any subsequent corrections.

Frontal fibrosing alopecia: there is no statistically significant association with leave-on facial skin care products and sunscreens

We were interested to read the article Frontal Fibrosing Alopecia - Possible Association with Leave-on Facial Skin Care Products and Sunscreens; A Questionnaire Study by Aldoori et al1. The authors sought to identify possible causative environmental factors associated with frontal fibrosing alopecia (FFA). One conclusion was that the use of facial products containing sunscreens might be implicated. This article is protected by copyright. All rights reserved.

261 Tissue and circulating microRNA co-expression analysis reveals potential involvement of miRNAs in the pathobiology of frontal fibrosing alopecia

Citing this paper Please note that where the full-text provided on Kings Research Portal is the Author Accepted Manuscript or Post-Print version this may differ from the final Published version. If citing, it is advised that you check and use the publishers definitive version for pagination, volume/issue, and date of publication details. And where the final published version is provided on the Research Portal, if citing you are again advised to check the publishers website for any subsequent corrections.