Faculty Bibliography

We applaud Debroy-Kidambi et al for repeating their questionnaire study in male patients to determine possible environmental exposures that could be contributing to the increasing incidence of frontal fibrosing alopecia (FFA). In fact, in our own clinic we have noted that patients are often as interested in the possible causes of this condition as they are in available treatment methods. The discrepancy in facial moisturizer use between men with FFA compared to controls (94% versus 32%, p<0.0001) and the consistent use of primary sunscreens among FFA patients (35% versus 4%, p=0.0012) lends support to the hypothesis that a component of leave-on cosmetics may be contributing to the development of this condition

BACKGROUND: Thyroid dysfunction is classically associated with alopecia. Studies focusing on manual thyroid examinations, with ultrasonography of palpable abnormalities, in alopecia patients are lacking. OBJECTIVE: To examine the clinical utility of manual and sonographic evaluation of the thyroid in alopecia patients. METHODS: A retrospective chart review was performed among patients diagnosed with alopecia. RESULTS: We found that 20.2% (74/367) of manual thyroid exams performed were deemed abnormal and 78.8% (41/52) of patients who had an ultrasound had an abnormal finding. Twenty two of the 74 patients did not obtain the requested ultrasound. Non-scarring alopecia was associated with 36 of 41 patients with abnormal ultrasounds (Telogen effluvium 29.3%, Androgenetic alopecia 27.8%, Alopecia areata 24.4%, and Traction alopecia 9.8%). No one specific structural abnormality was associated with a specific hair loss type. Of note, 78% (32/41) of patients with an abnormal ultrasound exam had normal thyroid function tests and only 9/41 (22%) patients had both. LIMITATIONS: THESE INCLUDE: a retrospective study design, small sample size, use of multiple sites for laboratory and sonographic thyroid evaluation, and a high attrition rate for ultrasound evaluation. CONCLUSIONS: This study revealed that the manual examination of the thyroid in alopecia patients may identify additional thyroid abnormalities not detected with serologic evaluation alone. Further prospective studies are required to evaluate the necessity and significance of manual thyroid palpation and subsequent ultrasound studies in this patient population.