Frontal Fibrosing Alopecia and Sunscreen Use: A Cross-sectional Study of Actinic Damage

Patients with frontal fibrosing alopecia report higher rates of sunscreen use than control subjects. However, it is not known whether the higher use of sunscreen is a cause or a consequence of the alopecia. The aim of this study was to assess the presence of actinic damage in patients with frontal fibrosing alopecia. [AQ1] A cross-sectional study was carried out on 101 patients with frontal fibrosing alopecia and 40 control subjects. The presence of actinic damage, solar lentigines and actinic keratoses, and basal and squamous cell carcinomas was recorded in both groups, together with sunscreen use. Trichoscopy and skin biopsy were performed on patients. Actinic damage was present more frequently in patients with frontal fibrosing alopecia (69.3%) than in control subjects (50%) (p = 0.031). Patients used sunscreen more frequently than did control subjects (83.2% vs 62.5%, p = 0.008). However, the prevalence of trichoscopic inflammatory signs, peripheral alopecia, and inflammatory infiltrate and sebaceous gland involvement in skin biopsy, were similar in patients who used sunscreen and non-sunscreen users. In conclusion, patients with frontal fibrosing alopecia had greater actinic damage than did control subjects, and this is a possible reason for the higher use of sunscreen among patients. Thus, use of sunscreen may not be the trigger for frontal fibrosing alopecia that dermatologists have proposed.