Article summary by Jessica Brown-Korsah | MD Candidate 2024 | Case Western Reserve University School of Medicine.

There has been increasing evidence that lichen planopilaris/frontal fibrosing alopecia (LPP/FFA) may be caused by different environmental exposures. However, the exact cause is currently unknown. Prasad et al.’s studied 42 patients with FFA and/or LPP to identify which allergens affected patients with LPP and FFA. They also assessed whether avoiding these allergens improved the patients’ alopecia. The allergens tested within the study were from ingredients found in skin care products.

The 42 patients underwent patch testing. Patch testing is a medical test to determine what may cause a person to experience a rash or irritation in response to an exposure or substance. To perform patch testing, the dermatologist places small amounts of allergens on the skin and covers each allergen with a patch. The patient then leaves the patches on for 48 hours and returns to the dermatologist’s office for removal. Patients typically return in 4-7 days for a third visit as some reactions may take time to appear.

Of the 42 patients, 76% had clinically relevant allergens commonly found in cosmetics and personal care products that are applied to the scalp and face. The most common allergens were gallates, linalool, and fragrance mixes. Gallates are preservatives added to products to prevent the growth of fungi and bacteria. Linalool is a fragrance chemical found in several skin and hair care products. After 3 months of allergen avoidance, patients experienced decreased scalp redness and itching. However, further studies are needed to determine the connection between allergens and scarring forms of hair loss, such as FFA and LPP.

See full article here.

Reference: Prasad S, Marks DH, Burns LJ, et al. Patch testing and contact allergen avoidance in patients with lichen planopilaris and/or frontal fibrosing alopecia: A cohort study. J Am Acad Dermatol. 2020;83(2):659-661. doi:10.1016/j.jaad.2020.01.026