BH03 Comorbidities in patients with frontal fibrosing alopecia: a systematic review and meta-analysis of associated conditions

Abstract

Frontal fibrosing alopecia (FFA) is a cicatricial alopecia characterized by progressive frontotemporal hairline recession. Although the incidence has dramatically increased, the pathophysiology remains poorly understood and likely multifactorial. Various comorbidities have been reported in association with FFA, including autoimmune, thyroid, hormonal and metabolic disorders. We conducted a systematic review and meta-analysis to quantitatively assess associated comorbidities and further elucidate overlapping pathophysiology, to guide patient screening and future research. A comprehensive literature search was conducted in June 2025. All observational or interventional studies reporting comorbidities between 2009 and 2024 were included, irrespectively of the study outcome. Risk of bias was assessed using the Newcastle–Ottawa Scale. Random effects meta-analyses were used to estimate pooled odds ratios (ORs) in controlled studies or the pooled prevalence in single-arm studies. Sixty-five studies were included. Meta-analysis of controlled studies demonstrated significantly increased odds of thyroid disease (OR 1.78, P < 0.001), lupus erythematous (OR 5, P = 0.01), vitiligo (OR 4.63, P = 0.01) and heart disease (OR 2.1, P = 0.03) with FFA. Prevalence meta-analysis showed similarly higher rates in postmenopausal women, and higher rates of thyroid disorders, vitiligo and androgenetic alopecia. This study demonstrates a substantial burden of comorbidities in FFA, spanning hormonal, autoimmune, cardiometabolic and other dermatological disease, supporting the concept of FFA as a systemic disorder. The high prevalence of menopause and hormonal disorders supports a role for hormonal changes in disease onset or progression. Associations with thyroid disease and vitiligo suggest a possible shared pathogenic pathway involving immune dysregulation, supporting consideration of targeted screening in FFA. While cardiometabolic disease and cutaneous malignancy were frequently observed, these associations may be confounded by older patient populations and other demographic factors such as higher frequency of dermatologist visits. Overall, these findings establish a rationale for holistic patient assessment and highlight the need for well-designed, age- and sex-matched comparative studies to clarify true associations and better define the systemic nature of FFA.