Hair Shaft Morphology, Elemental Composition, and Nanoparticles in Frontal Fibrosing Alopecia: A Case-control Study.

Frontal fibrosing alopecia is a cicatricial alopecia with rising incidence. Titanium nanoparticles were suggested as a potential environmental trigger, yet this is unproven. This study assessed hair morphology, chemical composition and nanoparticles in 20 patients and 40 healthy controls using scanning electron micro-scopy and energy-dispersive X-ray spectroscopy. Morphological evaluation revealed a significantly higher degree of cuticle weathering in patients compared with controls when there were no differences in hair care routine. There were no differences in the background elemental composition, while particle analysis revealed a significant increase in particles containing titanium, chlorine, silicon, magnesium, and iron in the patient group. Titanium-containing nanoparticles showed the most significant increase, being 8.6 times greater than in controls, without relation to age and disease duration. The results indicate that patients with frontal fibrosing alopecia should be advised to avoid aggressive topical cosmetic and medical hair treatments, and refrain from using cosmetic preparations containing titanium nanoparticles.