Frontal Fibrosing Alopecia and Cyclines in Skin of Color Patients: A Retrospective Study of 50 Patients

Introduction: Frontal fibrosing alopecia (FFA) is a scarring alopecia that mainly affects women and is characterized by progressive frontal hairline recession and eyebrow loss. The efficacy of doxycycline in patients with skin of color remains underexplored. The objective of our study is to assess the clinical and dermoscopic response to doxycycline in patients with FFA and skin of color. Methods: A retrospective study was conducted over 4 years at Ibn Sina University Hospital, Rabat. Fifty female patients with FFA received oral doxycycline (100 mg/day) for at least 6 months. Disease patterns, associated conditions (lichen planus pigmentosus and rosacea), and treatment response were evaluated. Statistical significance was set at p < 0.05. Results: Median age was 52 years; 60% were postmenopausal. Linear FFA was most common (70%), and 46% had lichen planus pigmentosus. Doxycycline led to improvement in 57% of patients (p = 0.02), particularly in linear and pseudo-fringe patterns. Dermoscopic improvements included decreased perifollicular erythema and hyperkeratosis (p = 0.01). All patients with rosacea improved. Adverse events occurred in 16% of cases. Conclusion: Doxycycline appears effective and well-tolerated in managing FFA in patients with skin of color, especially in cases associated with lichen planus pigmentosus or rosacea.