Clinical and Trichoscopic Evaluation of Beard in Men with Frontal Fibrosing Alopecia: A Multicenter Prospective Study

Introduction: Frontal fibrosing alopecia (FFA) is a scarring alopecia first described in 1994. It is more common in postmenopausal women, and its incidence has increased significantly among both premenopausal and postmenopausal women. FFA is less frequent in men and beard involvement occurs in 50-74% of male FFA patients. This study aimed to assess the clinical and trichoscopic features of beard involvement in FFA patients. Methods: After the Institutional Review Board's approval, a prospective multicenter study was conducted involving 25 male patients with FFA. Clinical photos were taken and trichoscopic images of 5 areas (sideburns, right-left lateral cheek, mustache, and chin) were obtained. Results: Beard hair loss was observed in all patients. Severe clinical involvement was associated with the presence of facial papules and with numerous concomitant (≥3) features (facial papules; lichen planus pigmentosus; loss of eyebrows, eyelashes, or body hair). Trichoscopic findings were present in all patients. Absence of follicular openings (100%), black dots (64%), perifollicular erythema (56%), broken hairs (56%), telangiectasias (56%), and white dots (48%) were the most prevalent findings. Conclusion: Clinical and trichoscopic beard involvement in male FFA were observed in all patients, and severe involvement including all areas of the beard was observed in half of the patients. The high incidence of facial papules and body hair loss may indicate a more severe clinical profile in men.