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New scoring system for hair loss

Article-New scoring system for hair loss

Spanish researchers have developed a scoring system to assess the severity of frontal fibrosing alopecia, a scarring form of alopecia marked by hairline recession and eyebrow loss primarily affecting postmenopausal women.

The scoring system, called Frontal Fibrosing Alopecia Severity Score (FFASS), evaluates inflammation, redness, scaling and extension. It is described in the March issue of the Journal of the American Academy of Dermatology.

“Developing a new classification of [frontal fibrosing alopecia] based on grades of severity can help in understanding the disease, predicting the long-term prognosis of the alopecia, and comparing the effectiveness of different treatments,” write researchers who were led by David Saceda Corralo, M.D., of Ramon y Cajal University Hospital in Madrid.

Frontal fibrosing alopecia (FFA) is increasing in incidence, especially among postmenopausal women, according to a review article published in the Journal of Cutaneous Medicine and Surgery in October 2017.

The new scoring system prevents investigators’ prejudices, the authors write. It evaluates eight clinical features of frontal fibrosing alopecia, which is considerably fewer than previous indexes. Frontotemporal hairline recession correlated best with clinical assessment and is the most important clinical feature in the scoring system.

The Frontal Fibrosing Alopecia Severity Score includes two categories of features, including the extent to alopecia and inflammation, which allow assessment of the role of clinical inflammation of alopecia progression.

To use the score, measure the recession of the frontotemporal hairline. Record the results in the patient’s medical record in order to repeat the same assessment at every visit and then check for improving or worsening of the disease, according to Dr. Saceda.


The study included 103 female patients with FFA who reported eyebrow loss (95%), eyelash loss (34%), occipital involvement (18%), hair loss on the limbs (73%), axillary and public hair loss (44%), depression of frontal veins (55%), perifollicular erythema (49%); perifollicular hyperkeratosis (59%); pruritus (50%); and pain (23%). 

Statistically significant associations were found between the Frontal Fibrosing Alopecia Severity Score and eyelash loss, body hair involvement, facial papules, depression of frontal veins or quality of life scores.

While the study was on women, the frontal Fibrosing Alopecia Severity Score works in a similar way in men.  

“Clinical presentation of frontal fibrosing alopecia in men is pretty similar. Frontotemporal hairline recession, clinical inflammation and symptoms can be assessed in the same way, so the scoring system is also valid,” Dr. Saceda writes. “However, in my experience, men are also very worried about the loss of the beard and the associated facial papules. These clinical features are not included in our scoring system and must be also evaluated in male patients.”


David Saceda-Corralo, MD; Óscar Muñoz Moreno-Arrones, MD; Pablo Fonda-Pascual, MD., et al. “Development and validation of the Frontal Fibrosing Alopecia Severity Score,” Journal of the American Academy of Dermatology. March 2018. DOI: