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Oral contraceptives may contribute to frontal fibrosing alopecia risk

Photo by Reproductive Health Supplies Coalition

Findings from a new study suggest that taking oral contraceptives could be linked to frontal fibrosing alopecia (FFA).

The study, published online ahead of print in JAMA Dermatology (May 29, 2024), builds on earlier research from the same team of investigators which identified mutations within certain genes that increase the risk of developing FFA. One of these is gene CYP1B1—a gene that codes for a metabolic enzyme that is responsible for metabolizing hormones.

Researchers enrolled female patients with FFA from U.K.-based dermatology clinics. The patients were matched with unrelated age- and ancestry-matched female control individuals derived from UK Biobank in a 1:66 ratio, determined by the first four principal components from genome-wide genotypes. Data were collected from July 2015 to Sept. 2017 and analyzed from Oct. 2022 to Dec. 2023.

The research team included recent PhD graduate Dr. Tuntas Rayinda and was led by Dr. Christos Tziotzios, Consultant Dermatologist and Senior Lecturer at St. John’s Institute of Dermatology, and Prof. Michael Simpson from the Department of Medical and Molecular Genetics, King’s College London.

They found that women who have a specific version of the CYP1B1 gene were more likely to develop FFA when they have also taken oral contraception. The authors write this finding supports currently existing models on the development of FFA, which results from a combination of genetic factors and environmental factors.

“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, in a press release. “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 contribution of the oral contraceptive to disease manifestation via gene-environment interaction.”

The authors write that they hope their study, in addition to improving the understanding of the combined genetic and environmental factors that drive FFA, can be applied to minimize the risk of FFA development. The team of researchers is now working on developing and making such a genetic test more widely available.

The study was supported by a British Skin Foundation award to Dr. Tziotzios. Dr. Tziotzios is funded by a Medical Research Council (MRC) Clinical Academic Research Partnership (CARP) award to support his collaborative partnership with Prof. Michael Simpson.


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