1. Frontal fibrosing alopecia: survey of severity assessment methods in routine clinical practice and validation of the International Frontal Fibrosing Alopecia Cooperative Group measurement guidance
- Author
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M. Mowbray, D Fairhurst, Martin S Wade, C Marshall, D M Cummins, S Zaheri, N Meah, Y Z Chiang, S Wong, Matthew Harries, J. Jones, V Joliffe, M R Kaur, C Heal, L Asfour, Christos Tziotzios, Andrew G. Messenger, C Champagne, Paul Farrant, S. Holmes, A. M Bryden, and A. Takwale
- Subjects
Treatment response ,medicine.medical_specialty ,business.industry ,Frontal fibrosing alopecia ,Lichen Planus ,Outcome measures ,Reproducibility of Results ,Alopecia ,Dermatology ,medicine.disease ,Test (assessment) ,Severity assessment ,Hair loss ,Surveys and Questionnaires ,medicine ,Physical therapy ,Humans ,Routine clinical practice ,business ,Reliability (statistics) - Abstract
BACKGROUND Lack of validated and responsive outcome measures in the management of Frontal Fibrosing Alopecia (FFA) significantly limits our ability to assess disease progression and treatment response over time. OBJECTIVES The aim of this study was to understand how FFA extent and progression is currently assessed in UK specialist centres, validate components of the International FFA Cooperative Group (IFFACG) statement on FFA assessment, and identify pragmatic advice to improve FFA management in clinic. METHODS Consultant Dermatologists with a specialist interest in hair loss (n=17) were invited to take part. Preferred FFA assessment methods were explored using questionnaires and clinical scenarios. Participants were asked to identify and mark the current hairline in 10 frontal and 10 temporal hairline images, with assessment repeated 3 months later (to assess intra-individual variability) and 12 months later (to test whether inter-individual accuracy could be improved with simple instruction). RESULTS All 17 clinicians (100%) completed the questionnaire at each time interval. We identified a wide variation in assessment techniques between our experts. Measurements were perceived as the most accurate method of assessing frontal recession whereas photography was preferred for temporal recession. Inter-rater reliability between clinicians measuring the frontal hairline scenarios indicated a moderate strength of agreement (ICC 0.613; 95% CI: 0.398 to 0.848), yet intra-rater reliability was found to be poor with wide limits of agreement (-8.71mm to 9.92mm) on follow-up. Importantly, when clear guidance was provided on how the hairline should be identified (questionnaire 3), inter-rater reliability improved significantly, with an ICC 0.702 suggesting moderate agreement (95% CI: 0.508 to 0.890; p
- Published
- 2022
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