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- W2885503602 abstract "To the Editor: We read with interest the paper by Sacceda-Corralo et al1Saceda-Corralo D. Morena-Arrones O.M. Fonda-Pascual P. et al.Development and validation of Frontal Fibrosing Alopecia Severity Score.J Am Acad Dermatol. 2018; 78: 522-529Abstract Full Text Full Text PDF Scopus (30) Google Scholar describing development of the Frontal Fibrosing Alopecia (FFA) Severity Score (FFASS). There is a pressing need for accurate prospective assessment of FFA to develop a better understanding of the natural history and allow more precise measurement of treatment effects and facilitate high-quality clinical trials. However, we take issue with several of the criticisms leveled at the Frontal Fibrosing Alopecia Severity Index (FFASI), which we published several years ago,2Holmes S. Ryan T. Young D. Harries M. Frontal Fibrosing Alopecia Severity Index: a validated scoring system for frontal fibrosing alopecia.Br J Dermatol. 2016; 175: 203-207Crossref PubMed Scopus (38) Google Scholar regarding lack of validation, scale criteria, and complexity. Eighty percent of the FFASI score comprises measurement of hairline alopecia and notes the presence of hair loss elsewhere (face and body) plus other disease features, including scalp lichen planopilaris and facial papules. The inclusion of these features reflects the clinical condition rather than personal bias. We consider extent of alopecia to be, inarguably, the most important feature in assessing disease severity and measuring progression prospectively. This opinion is reflected in the literature and articulated in the systematic review of FFA and lichen planopilaris treatments by Racz et al,3Racz E. Gho C. Moorman P.W. Noordhoek Hegt V. Neumann H.A. Treatment of frontal fibrosing alopecia and lichen planopilaris: a systematic review.J Eur Acad Dermatol Venereol. 2013; 27: 1461-1470Crossref PubMed Scopus (108) Google Scholar an opinion which the authors have concurred with previously.4Vano-Galvan S. Molina-Ruiz A.M. Serrano-Falcon C. et al.Frontal fibrosing alopecia: a multicenter review of 355 patients.J Am Acad Dermatol. 2014; 70: 670-678Abstract Full Text Full Text PDF PubMed Scopus (304) Google Scholar In their current paper, the authors comment “FFASI…includes 16 clinical features, some very uncommon in FFA and with a doubtful relationship with severity.” However, of these 16 criteria, 4 are included in FFASS (frontal, right, and left temporal band width and eyebrow loss) and comprise 84% of the FFASS assessment. A further 3 criteria (eyelash loss, body hair loss, and facial papules) have previously been reported as markers of severe disease (see below), and the other features are all reported in association with FFA, potentially reflecting a common pathogenesis. We accept that inclusion of associated lichenoid disorders has not been shown to correlate with FFA severity; however, as the spectrum of clinical features grows, learning more about these associations might provide useful insights into disease prognosis or pathogenesis. Particularly disingenuous is the assertion that “FFASS prevents investigators' prejudices,” relating to discussion of the strength of the FFASS over other scales (including FFASI) as the purported independent validation method (Investigator Global Assessment) presented represents a subjective assessment of overall severity by the study's authors. Furthermore, aspects of the validation are counter-intuitive, eg, that those with occipital hairloss do not have more severe disease. In a previous publication, the authors indicated that initial eyebrow loss had favorable prognostic implications, and eyelash loss, body hair loss, and facial papules were poor prognostic indicators.4Vano-Galvan S. Molina-Ruiz A.M. Serrano-Falcon C. et al.Frontal fibrosing alopecia: a multicenter review of 355 patients.J Am Acad Dermatol. 2014; 70: 670-678Abstract Full Text Full Text PDF PubMed Scopus (304) Google Scholar Similarly, the authors recently suggested that pattern of frontal loss was of significant prognostic relevance,5Morena-Arrones O.M. Saceda-Corralo D. Fonda-Pascual P. et al.Frontal fibrosing alopecia: clinical and prognostic classification.J Eur Acad Dermatol Venereol. 2017; 31: 1739-1745Google Scholar yet these features are not included in the FFASS. We feel it is important that there is clarity and consistency in disease severity methods to ensure confidence that the data generated is robust and reliable. Last, regarding FFASI usability, we have not found it cumbersome and both authors routinely use FFASI to collect clinical data in their hair clinics. Accurately measuring alopecia is challenging, and we consider that all FFA assessment tools will have flaws. Ultimately, what is important is that we attempt to measure FFA prospectively in a consistent and relevant manner whether by FFASS or FFASI. Development and validation of the Frontal Fibrosing Alopecia Severity ScoreJournal of the American Academy of DermatologyVol. 78Issue 3PreviewFrontal fibrosing alopecia (FFA) is a scarring alopecia characterized by recession of the frontotemporal hairline and loss of the eyebrows. Full-Text PDF Reply to: “Response to ‘Development and validation of the Frontal Fibrosing Alopecia Severity Score’”Journal of the American Academy of DermatologyVol. 79Issue 6PreviewTo the Editor: We thank Dr Holmes and Harries1 for their interest in the Frontal Fibrosing Alopecia (FFA) Severity Score (FFASS).2 We agree that there is an urgent need for a valid method to assess FFA to classify patients according to the severity of their disease and compare the efficacy of different treatments. The Frontal Fibrosing Alopecia Severity Index (FFASI) developed by Holmes et al was the first try to this aim.3 Full-Text PDF" @default.
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- W2885503602 date "2018-12-01" @default.
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- W2885503602 title "Response to “Development and validation of the Frontal Fibrosing Alopecia Severity Score”" @default.
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