Statement from the frontal fibrosing alopecia international expert alliance: SOFFIA 2024

Nekma Meah^{1

2}, Jane Li^{3

4

5}, Dmitri Wall^{6

7

8}, Katherine York⁹, Bevin Bhoyrul¹⁰, Laita Bokhari¹⁰, Lachlan Coulthard¹⁰, Leila Asfour¹¹, Leonardo Spagnol Abraham^{12

13}, Daniel Asz-Sigall¹⁴, Wilma F Bergfeld¹⁵, Regina C Betz¹⁶, Ulrike Blume-Peytavi¹⁷, Valerie Callender^{18

19}, Vijaya Chitreddy¹⁰, Andrea Combalia²⁰, George Cotsarelis²¹, Brittany Craiglow²², Rachita Dhurat²³, Ncoza Dlova^{24

25}, Jeff Donovan^{26

27}, Andrei Doroshkevich²⁸, Samantha Eisman¹⁰, Paul Farrant²⁹, Aida Gadzhigoroeva^{30

31}, Jack Green³², Ramon Grimalt³³, Matthew Harries^{34

35}, Maria Hordinsky³⁶, Alan D Irvine³⁷, Victoria Jolliffe³⁸, Spartak Kaiumov³⁹, Brett King⁴⁰, Steven Kossard⁴¹, Joyce Lee⁴², Won-Soo Lee⁴³, Nino Lortkipanidze⁴⁴, Amy McMichael⁴⁵, Natasha Atanaskova Mesinkovska⁴⁶, Andrew Messenger⁴⁷, Paradi Mirmirani⁴⁸, Elise Olsen⁴⁹, Seth J Orlow^{50

51}, Yuliya Ovcharenko⁵², Bianca Maria Piraccini^{53

54}, Rodrigo Pirmez⁵⁵, Adriana Rakowska⁵⁶, Pascal Reygagne⁵⁷, Janet Roberts⁵⁸, Lidia Rudnicka⁵⁶, David Saceda-Corralo^{59

60}, Jerry Shapiro⁵⁰, Pooja Sharma¹⁰, Tatiana Silyuk²⁸, Poonkiat Suchonwanit⁶¹, Anita Takwale⁶², Antonella Tosti⁶³, W I Visser⁶⁴, Sergio Vañó-Galván^{59

60

65}, Annika Vogt¹⁷, Martin Wade⁶⁶, Leona Yip⁶⁷, Abraham Zlotogorski⁶⁸, Cheng Zhou⁶⁹, Rodney Sinclair^{10

70}

Affiliations

¹ Mersey and West Lancashire Teaching Hospitals NHS Trust, St Helens, UK.
² Manchester University, Faculty of Biology, Medicine and Health, Manchester, UK.
³ Department of Medicine (Dermatology), St Vincent's Hospital Melbourne, the University of Melbourne, Fitzroy, Victoria, Australia.
⁴ The Skin Health Institute, Carlton, Victoria, Australia.
⁵ Department of Dermatology, Box Hill Hospital, Eastern Health, Box Hill, Victoria, Australia.
⁶ Hair Restoration Blackrock, Dublin, Ireland.
⁷ National and International Skin Registry Solutions (NISR), Charles Institute of Dermatology, University College Dublin, Dublin, Ireland.
⁸ The Mater Misericordiae University Hospital, Dublin, Ireland.
⁹ Beachside Specialist Group, Noosa Heads, Australia.
¹⁰ Sinclair Dermatology, Melbourne, Australia.
¹¹ Salford Royal Foundation Trust, Northern Care Alliance, Manchester, UK.
¹² Trichology Unit, Hospital Regional da Asa Norte, Brasilia, Brazil.
¹³ Programa de Pós Graduação Em Ciências Médicas (PPGCM), Universidade de Brasília (UnB), Brasilia, Brazil.
¹⁴ Trichology Clinic, Dermatology Department, Dr Manuel Gea Gonzalez General Hospital, Mexico City, Mexico.
¹⁵ Cleveland Clinic Main Campus, Cleveland, Ohio, USA.
¹⁶ Institute of Human Genetics, University of Bonn, Medical Faculty & University Hospital Bonn, Bonn, Germany.
¹⁷ Department of Dermatology, Venerology and Allergology, Clinical Research Center for Hair and Skin Science, Charité-Universitaetsmedizin Berlin, Berlin, Germany.
¹⁸ Howard University College of Medicine, Washington, DC, USA.
¹⁹ Callender Dermatology & Cosmetic Center, Glenn Dale, Maryland, USA.
²⁰ Dermatology Department, Hospital Clinic de Barcelona, Barcelona, Spain.
²¹ Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
²² Yale Department of Dermatology, New Haven, Connecticut, USA.
²³ Department of Dermatology, LTM Medical College & Hospital Sion, Mumbai, India.
²⁴ Chief Specialist and HOD Department of Dermatology, NRMSOM, UKZN, Durban, South Africa.
²⁵ Dean and Head School of Clinical Medicine, University of KwaZulu Natal, Durban, South Africa.
²⁶ Department of Dermatology, University of British Columbia, Vancouver, British Columbia, Canada.
²⁷ Donovan Hair Clinic, Whistler, British Columbia, Canada.
²⁸ Hair Treatment and Transplantation Center, Saint Petersburg, Russian Federation.
²⁹ Brighton and Sussex University Hospitals NHS Trust, Brighton, UK.
³⁰ Scientific & Practical Center Dermatolovenereology and Cosmetology of the Moscow City Health Department, Moscow, Russian Federation.
³¹ Institute of Beautiful Hairs, Moscow, Russia.
³² St.Vincent's Hospital, Skin Health Institute, Melbourne, Victoria, Australia.
³³ Facultat de Medicina i Ciències de la Salut, Universitat Internacional de Catalunya, Sant Cugat del Vallès (Barcelona), Spain.
³⁴ Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.
³⁵ Centre for Dermatology Research, Faculty of Biology, Medicine and Health, University of Manchester & NIHR Biomedical Research Centre, Manchester, UK.
³⁶ Department of Dermatology, University of Minnesota, Minneapolis, Minnesota, USA.
³⁷ Clinical Medicine, Trinity College Dublin, Dublin 2, Ireland.
³⁸ Centre for Cell Biology and Cutaneous Research, Blizard Institute, London, UK.
³⁹ Nautilus Clinic and Education Centre, Saint Petersburg, Russian Federation.
⁴⁰ Yale School of Medicine, New Haven, Connecticut, USA.
⁴¹ Director Kossard/ Laverty Dermatopathologists, Macquarie Park, New South Wales, Australia.
⁴² National Skin Centre, Singapore.
⁴³ Department of Dermatology, Yonsei Wonju University, Wonju, Korea.
⁴⁴ David Tvildiani Medical University, Head of Department of Dermatology and Venereology, Tbilisi, Georgia.
⁴⁵ Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.
⁴⁶ Department of Dermatology, University of California, Irvine, Irvine, California, USA.
⁴⁷ University of Sheffield, Sheffield, UK.
⁴⁸ Kaiser Permanente Vallejo, Department of Dermatology, Vallejo, California, USA.
⁴⁹ Duke Dermatology Clinic, Durham, North Carolina, USA.
⁵⁰ The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York, USA.
⁵¹ Department of Pediatrics, New York University Medical Center, New York, New York, USA.
⁵² Department of Infectious Diseases and Clinical Immunology of the V.N. Karazin KharkivNational University, Kharkiv, Ukraine.
⁵³ Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
⁵⁴ Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.
⁵⁵ Instituto de Dermatologia Professor Rubem David Azulay, Santa Casa da Misericórdia Do Rio de Janeiro, Rio de Janeiro, Brazil.
⁵⁶ Department of Dermatology, Medical University of Warsaw, Warsaw, Poland.
⁵⁷ Directeur du Centre de santé Sabouraud, Hopital Saint Louis, Paris, France.
⁵⁸ Northwest Dermatology Institute, Portland, Oregon, USA.
⁵⁹ Dermatology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain.
⁶⁰ IRYCIS, Universidad de Alcalá, Madrid, Spain.
⁶¹ Division of Dermatology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
⁶² Department of Dermatology, Gloucestershire Hospitals NHS Foundation Trust, UK.
⁶³ Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami, Miller School of Medicine, Coral Gables, Florida, USA.
⁶⁴ Division of Dermatology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
⁶⁵ Director of Hair Disorders Unit and #TricoHRC Research Group, Madrid, Spain.
⁶⁶ The London Skin and Hair Clinic, London, UK.
⁶⁷ Skin Partners Specialist Dermatologists, Brisbane, Australia.
⁶⁸ Department of Dermatology, Hadassah Medical Center, Hebrew University of Jerusalem, the Faculty of Medicine, Jerusalem, Israel.
⁶⁹ Department of Dermatology, Peking University People's Hospital, Beijing, China.
⁷⁰ Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia.

PMID: 40698981
DOI: 10.1111/jdv.20833

Free article

Statement from the frontal fibrosing alopecia international expert alliance: SOFFIA 2024

Nekma Meah et al. J Eur Acad Dermatol Venereol. 2025.

Free article

. 2025 Jul 23.

doi: 10.1111/jdv.20833. Online ahead of print.

Authors

Affiliations

¹ Mersey and West Lancashire Teaching Hospitals NHS Trust, St Helens, UK.
² Manchester University, Faculty of Biology, Medicine and Health, Manchester, UK.
³ Department of Medicine (Dermatology), St Vincent's Hospital Melbourne, the University of Melbourne, Fitzroy, Victoria, Australia.
⁴ The Skin Health Institute, Carlton, Victoria, Australia.
⁵ Department of Dermatology, Box Hill Hospital, Eastern Health, Box Hill, Victoria, Australia.
⁶ Hair Restoration Blackrock, Dublin, Ireland.
⁷ National and International Skin Registry Solutions (NISR), Charles Institute of Dermatology, University College Dublin, Dublin, Ireland.
⁸ The Mater Misericordiae University Hospital, Dublin, Ireland.
⁹ Beachside Specialist Group, Noosa Heads, Australia.
¹⁰ Sinclair Dermatology, Melbourne, Australia.
¹¹ Salford Royal Foundation Trust, Northern Care Alliance, Manchester, UK.
¹² Trichology Unit, Hospital Regional da Asa Norte, Brasilia, Brazil.
¹³ Programa de Pós Graduação Em Ciências Médicas (PPGCM), Universidade de Brasília (UnB), Brasilia, Brazil.
¹⁴ Trichology Clinic, Dermatology Department, Dr Manuel Gea Gonzalez General Hospital, Mexico City, Mexico.
¹⁵ Cleveland Clinic Main Campus, Cleveland, Ohio, USA.
¹⁶ Institute of Human Genetics, University of Bonn, Medical Faculty & University Hospital Bonn, Bonn, Germany.
¹⁷ Department of Dermatology, Venerology and Allergology, Clinical Research Center for Hair and Skin Science, Charité-Universitaetsmedizin Berlin, Berlin, Germany.
¹⁸ Howard University College of Medicine, Washington, DC, USA.
¹⁹ Callender Dermatology & Cosmetic Center, Glenn Dale, Maryland, USA.
²⁰ Dermatology Department, Hospital Clinic de Barcelona, Barcelona, Spain.
²¹ Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
²² Yale Department of Dermatology, New Haven, Connecticut, USA.
²³ Department of Dermatology, LTM Medical College & Hospital Sion, Mumbai, India.
²⁴ Chief Specialist and HOD Department of Dermatology, NRMSOM, UKZN, Durban, South Africa.
²⁵ Dean and Head School of Clinical Medicine, University of KwaZulu Natal, Durban, South Africa.
²⁶ Department of Dermatology, University of British Columbia, Vancouver, British Columbia, Canada.
²⁷ Donovan Hair Clinic, Whistler, British Columbia, Canada.
²⁸ Hair Treatment and Transplantation Center, Saint Petersburg, Russian Federation.
²⁹ Brighton and Sussex University Hospitals NHS Trust, Brighton, UK.
³⁰ Scientific & Practical Center Dermatolovenereology and Cosmetology of the Moscow City Health Department, Moscow, Russian Federation.
³¹ Institute of Beautiful Hairs, Moscow, Russia.
³² St.Vincent's Hospital, Skin Health Institute, Melbourne, Victoria, Australia.
³³ Facultat de Medicina i Ciències de la Salut, Universitat Internacional de Catalunya, Sant Cugat del Vallès (Barcelona), Spain.
³⁴ Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.
³⁵ Centre for Dermatology Research, Faculty of Biology, Medicine and Health, University of Manchester & NIHR Biomedical Research Centre, Manchester, UK.
³⁶ Department of Dermatology, University of Minnesota, Minneapolis, Minnesota, USA.
³⁷ Clinical Medicine, Trinity College Dublin, Dublin 2, Ireland.
³⁸ Centre for Cell Biology and Cutaneous Research, Blizard Institute, London, UK.
³⁹ Nautilus Clinic and Education Centre, Saint Petersburg, Russian Federation.
⁴⁰ Yale School of Medicine, New Haven, Connecticut, USA.
⁴¹ Director Kossard/ Laverty Dermatopathologists, Macquarie Park, New South Wales, Australia.
⁴² National Skin Centre, Singapore.
⁴³ Department of Dermatology, Yonsei Wonju University, Wonju, Korea.
⁴⁴ David Tvildiani Medical University, Head of Department of Dermatology and Venereology, Tbilisi, Georgia.
⁴⁵ Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.
⁴⁶ Department of Dermatology, University of California, Irvine, Irvine, California, USA.
⁴⁷ University of Sheffield, Sheffield, UK.
⁴⁸ Kaiser Permanente Vallejo, Department of Dermatology, Vallejo, California, USA.
⁴⁹ Duke Dermatology Clinic, Durham, North Carolina, USA.
⁵⁰ The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York, USA.
⁵¹ Department of Pediatrics, New York University Medical Center, New York, New York, USA.
⁵² Department of Infectious Diseases and Clinical Immunology of the V.N. Karazin KharkivNational University, Kharkiv, Ukraine.
⁵³ Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
⁵⁴ Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.
⁵⁵ Instituto de Dermatologia Professor Rubem David Azulay, Santa Casa da Misericórdia Do Rio de Janeiro, Rio de Janeiro, Brazil.
⁵⁶ Department of Dermatology, Medical University of Warsaw, Warsaw, Poland.
⁵⁷ Directeur du Centre de santé Sabouraud, Hopital Saint Louis, Paris, France.
⁵⁸ Northwest Dermatology Institute, Portland, Oregon, USA.
⁵⁹ Dermatology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain.
⁶⁰ IRYCIS, Universidad de Alcalá, Madrid, Spain.
⁶¹ Division of Dermatology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
⁶² Department of Dermatology, Gloucestershire Hospitals NHS Foundation Trust, UK.
⁶³ Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami, Miller School of Medicine, Coral Gables, Florida, USA.
⁶⁴ Division of Dermatology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
⁶⁵ Director of Hair Disorders Unit and #TricoHRC Research Group, Madrid, Spain.
⁶⁶ The London Skin and Hair Clinic, London, UK.
⁶⁷ Skin Partners Specialist Dermatologists, Brisbane, Australia.
⁶⁸ Department of Dermatology, Hadassah Medical Center, Hebrew University of Jerusalem, the Faculty of Medicine, Jerusalem, Israel.
⁶⁹ Department of Dermatology, Peking University People's Hospital, Beijing, China.
⁷⁰ Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia.

PMID: 40698981
DOI: 10.1111/jdv.20833

Abstract

Background: As the incidence of frontal fibrosing alopecia (FFA) continues to rise, there is a need for an optimal treatment algorithm for FFA.

Objective: To produce an international consensus statement on the treatment modalities and prognostic indicators of FFA.

Methods: Sixty-nine hair experts from six continents were invited to participate in a three-round Delphi process. The final stage was held as a virtual meeting facilitated via Zoom. The consensus threshold was set at ≥66%.

Results: Of 365 questions, expert consensus was achieved in 204 (56%) questions following completion of the three rounds. Three additional questions were included at the final meeting. The category with the strongest consensus agreement was disease monitoring (9; 100%). Questions pertaining to physical therapies achieved the least category consensus (15; 40%), followed by systemic therapy (45; 43%).

Limitations: The study lacked sufficient representation from Africa and South America.

Conclusion: SOFFIA highlights areas of agreement and disagreement among experts. Robust research is warranted to provide evidence-based treatment recommendations.

Keywords: Delphi; consensus; frontal fibrosing alopecia; therapeutic guideline.

PubMed Disclaimer

References

REFERENCES

1. Kossard S. Postmenopausal frontal fibrosing alopecia: scarring alopecia in a pattern distribution. Arch Dermatol. 1994;130(6):770–774.
1. Mirmirani P, Tosti A, Goldberg L, Whiting D, Sotoodian B. Frontal fibrosing alopecia: an emerging epidemic. Skin Appendage Disord. 2019;5(2):90–93.
1. Olsen E, Harries M, Tosti A, Bergfeld W, Blume‐Peytavi U, Callender V, et al. Guidelines for clinical trials of frontal fibrosing alopecia: consensus recommendations from the international FFA cooperative group (IFFACG). Br J Dermatol. 2021;185(6):1221–1231.
1. Ho A, Shapiro J. Medical therapy for frontal fibrosing alopecia: a review and clinical approach. J Am Acad Dermatol. 2019;81(2):568–580.
1. Gerbens LA, Boyce AE, Wall D, Barbarot S, de Booij RJ, Deleuran M, et al. TREatment of ATopic eczema (TREAT) registry taskforce: protocol for an international Delphi exercise to identify a core set of domains and domain items for national atopic eczema registries. Trials. 2017;18(1):87.

Grants and funding

LinkOut - more resources

Full Text Sources
Research Materials
- NCI CPTC Antibody Characterization Program

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

Statement from the frontal fibrosing alopecia international expert alliance: SOFFIA 2024

Affiliations

Statement from the frontal fibrosing alopecia international expert alliance: SOFFIA 2024

Authors

Affiliations

Abstract

References

REFERENCES

Grants and funding

LinkOut - more resources

Full Text Sources

Research Materials