June 2024

In search of environmental factors contributing to frontal fibrosing alopecia

A recent study in JAMA Dermatology, which was funded by the British Skin Foundation through the Young Investigator Award, examines the potential connection between taking the oral contraceptive pill and a type of hair loss called frontal fibrosing alopecia (FFA).

This study was led by Dr. Christos Tziotzios, a Consultant Dermatologist and Senior Lecturer at St. John’s Institute of Dermatology, King’s College London in collaboration with Prof Michael Simpson from the Department of Medical and Molecular Genetics and Prof John McGrath from St. John’s Institute of Dermatology, and was carried out by Dr. Tuntas Rayinda, a recent PhD graduate.

What is frontal fibrosing alopecia?

Frontal fibrosing alopecia (FFA) is a distressing skin disorder characterised by inflammation, scarring, and irreversible hair loss. Predominantly affecting women, the incidence of FFA has been increasing since its first description in 1994. FFA is believed to result from a combination of genetic and environmental factors. Despite ongoing research, the exact disease mechanism have remained unknown, making it a challenging condition to fully understand, prevent and treat.

What aspect of FFA was studied?

The study team have previously discovered that gene CYP1B1 (which encodes the enzyme CYP1B1, important in the metabolism of exogenous hormones including oral contraception) is causally associated with FFA. The research focused on understanding whether taking the oral contraceptive pill could be linked to the development of FFA, particularly in women with specific genetic mutations in the responsible gene. The hypothesis was further supported by a prior study they undertook on identical twins. Data was collected from women with FFA across the UK between July 2015 and September 2017 and compared against women without FFA from the UK Biobank.

What has been found so far from this research?

The research found that women with a specific version of the CYP1B1 gene who also took oral contraceptives were more likely to develop FFA. This supports the hypothesis that FFA results from a combination of genetic susceptibility and environmental factors, such as hormone metabolism influenced by oral contraceptives.

Implications and hopes for the future

This study is ground-breaking as it is the first to explore the interaction between genetic factors and environmental factors (like oral contraceptive use) in the development of FFA. These findings support existing models that FFA results from a combination of genetic predisposition and environmental triggers. The researchers hope their findings will lead to the development of genetic tests to minimise the risk of FFA. They are currently working on making such tests more widely available.

Dr Christos Tziotzios, Consultant Dermatologist & Senior Lecturer, Genetic Skin Disease Group, St John's Institute of Dermatology expresses his gratitude to the British Skin Foundation for supporting their groundbreaking research:

Our study is the first ever gene-environment interaction study into frontal fibrosing alopecia (FFA), a lichenoid inflammatory and scarring condition affecting almost exclusively women. We have previously identified causal variation in a hormone-metabolism related gene, conferring susceptibility to this increasingly common and highly distressing disease. We have now demonstrated contribution of the oral contraceptive to disease manifestation via gene-environment interaction. We are very grateful to all our referring clinicians in the UK, all clinical and research staff, our patients, and the British Skin Foundation, for financially supporting our work.

Find Dr Christos Tziotzios here.

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