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A groundbreaking study published in JAMA Dermatology has revealed a potential link between the use of oral contraceptives and the development of frontal fibrosing alopecia (FFA), a distressing skin disorder characterized by inflammation, scarring, and irreversible hair loss.
FFA, first described in 1994, has seen a continuous rise in cases, predominantly affecting women. The disorder’s increasing prevalence has led scientists and clinicians to suspect that both environmental and genetic factors contribute to its development.
The study, conducted by Dr. Tuntas Rayinda, a recent Ph.D. graduate, and led by Dr. Christos Tziotzios, Consultant Dermatologist & Senior Lecturer at St. John’s Institute of Dermatology, and Prof. Michael Simpson from the Department of Medical and Molecular Genetics, builds on previous research identifying genetic mutations that increase the risk of FFA. One such gene is CYP1B1, which codes for a metabolic enzyme responsible for hormone metabolism.
Investigating women with FFA, the researchers found that those with a specific version of the CYP1B1 gene were more likely to develop the condition if they had also taken oral contraceptives. The data, collected from women across the U.K. between July 2015 and September 2017, were compared with data from women without FFA from the UK Biobank. These findings support existing models suggesting that FFA results from a combination of genetic and environmental factors.
The study’s authors hope their findings will improve understanding of the factors driving FFA and help minimize the risk of its development. The team is now working on developing a genetic test to make such screenings more widely available.
“Our study is the first-ever gene-environment interaction study into frontal fibrosing alopecia (FFA), a lichenoid inflammatory and scarring condition affecting almost exclusively women,” said Dr. Tziotzios. “We have previously identified causal variation in a hormone-metabolism related gene, conferring susceptibility to this increasingly common and highly distressing disease. We have now demonstrated the contribution of oral contraceptives to disease manifestation via gene-environment interaction.”
Dr. Tziotzios expressed gratitude to the referring clinicians, clinical and research staff, patients, and the British Skin Foundation for their support.
For more information, refer to the study by Tuntas Rayinda et al., “Gene-Environment Interaction Between CYP1B1 and Oral Contraception on Frontal Fibrosing Alopecia,” published in JAMA Dermatology (2024).
