Socioeconomic Factors May Overshadow Racial Emphasis in Frontal Fibrosing Alopecia: Study Shows

The study, published in the Journal of the American Academy of Dermatology and led by Jiana Wyche and colleagues from Meharry Medical College, examined the association between socioeconomic status and the prevalence of FFA. FFA is a type of scarring alopecia that has seen a steady rise in cases over recent years. Historically, it has been reported more frequently in White, postmenopausal women. However, the growing number of cases has prompted investigations into potential environmental and lifestyle factors—including the use of facial cosmetics and sunscreens—which tend to be more common in individuals from higher socioeconomic backgrounds.

To better understand the role of socioeconomic status in FFA, researchers conducted a retrospective cohort analysis of patients from Johns Hopkins Hospital, Baltimore, over nine years (2015–2024). The study included 147 individuals diagnosed with FFA and 429 with AA, a condition chosen for comparison due to its similar immune-mediated mechanism. Data were collected from patients across 15 U.S. states, with a large majority (over 84%) from Maryland.

Using the CDC's Social Vulnerability Index—an indicator that incorporates data on income, education, housing, and other demographic factors—the team assessed the socioeconomic background of each patient based on their zip code. The SVI categorizes areas into four levels of vulnerability, with "low vulnerability" (SVI < 0.25) representing the most affluent areas.

The key findings of the study were as follows:

• Patients with frontal fibrosing alopecia (FFA) were significantly more likely to live in low-vulnerability (more affluent) zip codes compared to those with alopecia areata (AA), with rates of 50.3% vs. 34.03%.
• The likelihood of an FFA patient residing in an affluent area was notably higher, with an odds ratio of 1.786.
• When researchers adjusted for age and socioeconomic status, race was no longer found to be an independent predictor of FFA.
• Although unadjusted data showed FFA was more common in White individuals and AA in Black individuals, the adjusted analysis suggests these racial patterns may actually reflect underlying socioeconomic differences.

“Our study suggests that FFA patients are more likely to be from affluent zip codes as determined by their SVI when compared to AA patients,” the researchers wrote. “We believe, therefore, that historical emphasis on race in FFA may have been overstated due to the impact of race on socioeconomic status.”

They concluded, "These findings offer new insights into the factors contributing to FFA and highlight the importance of considering social and economic contexts in dermatologic research and diagnosis."

Reference:

Wyche J, Tsang DA, Aguh C. Odds of developing frontal fibrosing alopecia more closely tied to affluence than race - A retrospective cohort study. J Am Acad Dermatol. 2025 May 16:S0190-9622(25)02133-4. doi: 10.1016/j.jaad.2025.05.1394. Epub ahead of print. PMID: 40383279.