Frontal fibrosing alopecia (FFA) causes hair loss and scarring at the hairline, where your hair meets your forehead and temples. doi:10.1111/j.1365-4632.2004.02251.x Frontal fibrosing alopecia, or just FFA, is a type of lichen planopilaris. Mayo Clinic offers appointments in Arizona, Florida and Minnesota and at Mayo Clinic Health System locations. Frontal fibrosing alopecia (FFA) is scarring alopecia that mainly affects women. If you have early-stage FFA, this medication may also help regrow some hair. It affects both men and women, and its treatment depends upon its cause, age of onset, and clinical presentation. The follicle is irreparably damaged and replaced by fibrotic tissue. Patients with FFA are often quite healthy and use vitamin D supplements, although with calcium. To date, there are no randomized controlled trials evaluating efficacy of treatments. Eyebrow loss affects between 80% and 90% of women with FFA. FFA mainly affects women after age 50, though men and younger people can also have this condition. All of these types of hair loss can often be diagnosed with a scalp biopsy. Minoxidil: This is a popular hair loss treatment. Careers. Woman holding product in store pharmacy aisleThere have been reports of patients who have FFA seeing results when they take finasteride (described above) daily and apply minoxidil to their scalp twice a day. You should also try to begin treatment for FFA as early as possible. The longer you wait, the more hair loss you may see. other information we have about you. Int J Dermatol. Copyright 2023 Haymarket Media, Inc. All Rights Reserved. Find out why dark spots appear and what can fade them. Please login or register first to view this content. In a study that looked at FFA in Black women, researchers found that many of the patients also had traction alopecia. Strazzulla LC, Avila L, et al. These dermatologists' tips tell you how to protect your skin. This is a type of hair loss that develops when the hair is pulled tightly in the same way for a long time. Your use of this website constitutes acceptance of Haymarket Medias Privacy Policy and Terms & Conditions. However, if the strain is prolonged, traction alopecia can advance to scarring alopecia which is non-reversible and difficult to treat. ThickTails Hair Growth Shampoo and Conditioner (2-Pack) for Women with Thinning . Given the similarity and status of vitamin D levels across our patients, vitamin D deficiency is unlikely to be implicated in the pathogenesis of FFA. Both women were post-menopausal. Recommendations on screening for chloroquine and hydroxychloroquine retinopathy (2016 revision). To continue seeing results, you must continue to take a daily pill and apply minoxidil. It is divided into scarring and non-scarring alopecia. If you think you might have FFA, your dermatologist will be able to confirm whether or not . Scarring alopecia in a pattern distribution. First, What Is Frontal Fibrosing Alopecia?Frontal fibrosing alopecia, or just FFA, is a type of lichen planopilaris. Eyebrow regrowth in patients with frontal fibrosing alopecia treated with intralesional triamcinolone acetonide. But biotin has been shown to help with preventing balding and hair loss. To continue seeing results, you must continue to take a daily pill and apply minoxidil. Finasteride or dutasteride: Studies show that including one of these medications in the treatment plan can prevent further hair loss. The difference in findings between our patients with FFA and those with lichen planopilaris in the study by Conic et al4 suggests that larger studies with more diverse populations may be beneficial. People may be at higher risk of frontal fibrosing alopecia if they have: Frontal fibrosing alopecia is a somewhat rare condition, but growing numbers of people around the world are getting it. This combination takes time to work. Other possible effects include nausea, dizziness, vomiting, and loss of appetite. Frontal fibrosing alopecia, lichen planopilaris, and folliculitis decalvans are all types of scarring alopecia. Your healthcare provider may suggest a combination of medications, including: Depending on the treatment, you may start to see a slowing of hair loss in six to 18 months. Once the laser therapy stopped, only two patients kept the hair they regrew. Hair loss can affect all parts of the body, and almost total loss from limbs is common. androgenetic alopecia and particularly frontal fibrosing alopecia - are more common in women as we get . Advertising revenue supports our not-for-profit mission. Register for free and gain unlimited access to: - Clinical Updates, with personalized daily picks for you In fact, patients with lichen planopilaris had an average vitamin D level of 24.6 ng/mL and this translated to an 8.3-fold increased odds of severe vitamin D deficiency compared with controls. Frontal fibrosing alopecia developing after hair transplantation for androgenetic alopecia. You'll soon start receiving the latest Mayo Clinic health information you requested in your inbox. Most treatment plans use a combination of therapies, as this tends to give patients the best outcome. The real solution for frontal fibrosing alopecia may be found in treatments that help with hair regrowth. display: none; Characteristic Subcategory N (%)Age range, y16-90Mean age, yCombined 56FFA 63FPHL 51EthnicityFFA Caucasian 97 (97)Asian 2 (2)African 1 (1)FPHL Caucasian 83 (83)Asian 16 (16)African 1 (1)Smoking statusSmoker 2 (1)Nonsmoker 198 (99)Comorbidities (at least 1 additional comorbidity)FFA 63 (63)FPHL 52 (52)Open in a separate windowFFA, Frontal fibrosing alopecia; FPHL, female pattern hair loss. In this case, it attacks the scalp hair follicles. While it has yet to be proven, some studies suggest that your personal care products can affect FFA. Facial sunscreen products have been suggested as possible external etiologic contributors, and avoidance is recommended by some hair specialists as part of the treatment1,2; nevertheless, this theory requires further research to substantiate. An increasingly common type of hair loss in older women is a receding hairline, called frontal fibrosing alopecia (FFA). Note: The findings from small studies are shown below. But in this article were going to focus on treatments for the frontotemporal area, which includes the frontal area. Laser therapy, to reduce itchiness and swelling. By Prof. Dr. Soner Tatlidede 2020-02-20. Nonscarring alopecias include male and female pattern alopecias, alopecia areata, telogen effluvium . A dermatologist is a medical doctor who specializes in treating the skin, hair, and nails. include protected health information. The site is secure. Natalie tried many acne products without success. Patients taking vitamin D supplementation were excluded. Frontal fibrosing alopecia (FFA) is a primary cicatricial alopecia characterized by loss of follicular stem cells, fibrosis, and a receding frontotemporal hairline, with frequent loss of eyebrows, and less commonly, body hair involvement. 2018;78(1):203-5. Conflicts of interest: Dr Shapiro is a consultant for Aclaris Therapeutics, Incyte, and RepliCel Life Sciences and is a principal investigator for RegenLab. with the most positive treatment responses (88%, 181/204 for intralesional steroids Low-dose naltrexone for disease prevention and quality of life. In one study, 10 out of 11 patients who had lost their eyebrows saw some regrowth after being treated with injections of corticosteroids. When used along with treatment, self-care can improve your overall results. doi:10.1016/j.jaad.2012.09.043 They usually suggest a combination of medications to treat this condition. It should not be considered a substitute for professional medical advice. It affects people mostly in their early to mid 20s and there is no known cause of frontal fibrosing alopecia, nor is there a cure! Wearing accessories such as a hat, headband or wig. Frontal fibrosing alopecia (FFA) is a form of lymphocytic cicatricial alopecia that presents as frontotemporal hairline recession, typically in postmenopausal women. Although it has been suggested that FFA may be due to hormonal . Those studies will be important to do and will require a larger study to have enough patients to make meaningful conclusions. (https://www.karger.com/Article/Fulltext/495117), (https://rarediseases.info.nih.gov/diseases/10886/frontal-fibrosing-alopecia). 2019. Table IIVitamin D status in FFA and control groups. Many people lose some (or all) of their eyebrows. Researchers dont know the exact cause of FFA, but they believe an autoimmune reaction, genetics or hormones may play a role. Last reviewed by a Cleveland Clinic medical professional on 06/13/2022. There was no difference in vitamin D levels across different age groups such as less than 50, 50-59 and greater than 60. Hydroxychloroquine: This medication may reduce symptoms like itch and pain in patients who have FFA. About 20 % of patients with FFA and 20 % of patients with female androgenetic alopecia have suboptimal vitamin D levels. Lichen planopilaris: epidemiology and prevalence of subtypes-a retrospective analysis in 104 patients. The role of vitamin D in frontal fibrosing alopecia (FFA) is not clear. Prognosis, treatment, and disease outcomes in frontal fibrosing alopecia: A retrospective review of 92 cases. J Am Acad Dermatol. Alopecia can result from skin conditions such as eczema and psoriasis where scratching damages the hair follicles. Although there isnt a cure for FFA, early treatment can help slow its progress. Heres how long botox tends to last. It often leads to scaring in this area as well. Conic et al4 noted the capability of vitamin D to alter the immune response, possibly by increasing the autoreactive T cells. Sharing experiences with others in a similar situation can be a great source of comfort and information. and 88%, 158/180 for 5-reductase inhibitors). Lessening use of heated styling tools such as curling irons and hair dryers to decrease inflammation from heat. It is thought to be related to another condition called lichen planus which, when it affects the scalp, is called American Academy of Dermatology (AAD) Association. Treatment with over-the-counter minoxidil foam (5 percent) may prevent further hair loss and result in improved hair density. Histopathology of scarring and nonscarring hair loss. Finally, its worth noting in this study that the average 25 OH vitamin D levels in FFA were 68.9 nmol/L (27.6 ng/mL). Healthcare providers can use treatments to slow frontal fibrosing alopecia. information highlighted below and resubmit the form. Kossard S. Postmenopausal frontal fibrosing alopecia: scarring alopecia in a pattern distribution. Note: The findings from small studies are shown below. Your hairline may move back on your scalp. You may opt-out of email communications at any time by clicking on We hope youre enjoying the latest clinical news, full-length features, case studies, and more. Below 50ng/mL represents vitamin D insufficiency according to Australian therapeutic guidelines, characterized as mild (30-49nmol/L), moderate (12.5-29nmol/L), and severe (<12.5nmol/L). "Medical therapy for frontal fibrosing alopecia: A review and clinical approach." J Am Acad Dermatol. Mayo Clinic on Incontinence - Mayo Clinic Press, NEW The Essential Diabetes Book - Mayo Clinic Press, NEW Ending the Opioid Crisis - Mayo Clinic Press, FREE Mayo Clinic Diet Assessment - Mayo Clinic Press, Mayo Clinic Health Letter - FREE book - Mayo Clinic Press. Of eight patients who followed this treatment plan, half had no further hair loss after following this treatment plan for between 12 and 18 months. Frontal fibrosing alopecia (FFA) is a type of scarring alopecia that affects the frontal hairline and scalp. Risk of hydroxychloroquine alone and in combination with azithromycin in the treatment of rheumatoid arthritis: a multinational, retrospective study. Find out which vitamins may help you battle frontal fibrosing alopecia. Laser therapy. GET IN TOUCH. To the Editor: We read with great interest an observational study titled "Effectiveness of dutasteride in a large series of patients with frontal fibrosing alopecia in real clinical practice" by Pindado-Ortega et al, 1 another important study supporting the use of 5--reductase inhibitor (5ARI) as a part of the treatment arsenal for . If you notice a pattern of hair loss typical of FFA, talk with your doctor. For women, a receding hairline may be due to frontal fibrosing alopecia, or scarring of the scalp. The nice thing about this study is that it included patients who were not using vitamin D. Its a pretty rare thing to have FFA patients who dont use vitamin D in Canada. To perform a scalp biopsy, your dermatologist will numb part of your scalp and remove a small bit of tissue from your scalp. 2013 May;68(5):749-55. doi: 10.1016/j.jaad.2012.09.043. Frontal fibrosing alopecia (FFA) can cause permanent hair loss. This copyrighted material is provided by Natural Medicines Comprehensive Database Consumer Version. "Frontal fibrosing alopecia (FFA) is a . frontal-fibrosing-alopecia. display: none !important; Hereditary baldness (androgenic alopecia). -, Ladizinski B, Bazakas A, Selim MA, Olsen EA. Therefore, much of our knowledge is based on small retrospective studies. Washing your face with gentle, fragrance-free cleansers to avoid inflammation. Most women who experience hair loss notice a gradual broadening of the part in their hair (female-pattern hair loss). FFA most frequently occurs in postmenopausal women and is postulated to be a subtype of lichen planopilaris . Researchers dont know the exact cause of frontal fibrosing alopecia. Patients with frontal fibrosing alopecia (FFA) do not need to have vitamin D levels tested as deficiency is unlikely tied to the pathogenesis of FFA. While this medication helps some people, one possible side effect of taking this medication is hair loss. It is most commonly found in women who have gone through menopause and are generally over the age of 50, though it can . Smart Grocery Shopping When You Have Diabetes, Surprising Things You Didn't Know About Dogs and Cats, Smoking Pot Every Day Linked to Heart Risks, Artificial Sweetener Linked to Heart Risks, FDA Authorizes First At-Home Test for COVID and Flu, New Book: Take Control of Your Heart Disease Risk, MINOCA: The Heart Attack You Didnt See Coming, Health News and Information, Delivered to Your Inbox, IMPORTANT information about user generated content. Frontal fibrosing alopecia in men: an association with facial moisturizers and sunscreens. In some situations, people develop an edging that looks a bit spare with single hairs left behind in a balding area. If this medication is part of your treatment plan, you would take one pill every day. 3. 2019 Aug;81(2):568-580. doi: 10.1016/j.jaad.2019.03.079. Disclosure: Several study authors declared affiliations with biotech, pharmaceutical, and/or device companies. One major cause of hair loss is a fungal infection. A few patients saw regrowth of their eyebrows at three months. Frontal fibrosing alopecia: a retrospective analysis of 72 patients from a German academic center. If we combine this information with your protected 2020 Dec;28(3):188-189. This finding neither supports nor disproves an association between the application of facial sunscreen and FFA. 9,11 Decreased iron levels can contribute to hair loss so it may . Read Reviews (4) Treatment name PANTOTHENIC ACID (VITAMIN B5) Effectiveness: Insufficient Evidence. Hair loss often begins in the eyebrows or in the frontal hairline - or both. In addition to this, it can often cause the loss of a persons eyebrows. In one study, taking either of these medications prevented further hair loss in every patient with FFA. Could there, then, be a relationship between FFA and this type of deficiency? Frontal fibrosing alopecia: clinical presentations and prognosis. Unauthorized use of these marks is strictly prohibited. How do dermatologists diagnose frontal fibrosing alopecia?To find out if you have this type of hair loss, your dermatologist will: Examine your hairline, scalp, and eyebrows closely, Ask how long youve noticed the hair loss, Ask about symptoms like itch and pain and whether you have hair loss on any other part of your body, Talk with you about your health, medical conditions, and medications. It can smooth out deep wrinkles and lines, but the results arent permanent. These include PRP therapy in which platelet-rich plasma from the blood is extracted and administered in the scalp regions where hair loss is seen. Dermatology. Dr Wall reports honoraria from Janssen, grants from Pfizer, and consultancy with Eli Lilly and company and Bristol Myers Squibb, all outside the submitted work. Dermatologists care for people of all ages. Policy. You can search by location, condition, and procedure to find the dermatologist thats right for you. Healthcare providers diagnose FFA with a physical exam and skin biopsy. Corticosteroids: To reduce the inflammation caused by FFA, your dermatologist may inject this medication into your scalp. Other causes of scarring alopecia . Lancet Rheumatol. Without treatment, your hair loss may worsen over time. To find out if you have this type of hair loss, your dermatologist will: Examine your hairline, scalp, and eyebrows closely, Ask how long youve noticed the hair loss, Ask about symptoms like itch and pain and whether you have hair loss on any other part of your body, Talk with you about your health, medical conditions, and medications. a clinical approach to management. . For this reason, your dermatologist may recommend certain skin and hair care products. 1 The condition is considered to be a variant of lichen planopilaris (LPP) due to its similar histologic appearance. In this review, we highlight the various and most current treatment options for FFA, including 5--reductase inhibitors, intralesional steroids, hydroxychloroquine, topical steroids, topical calcineurin inhibitors, systemic retinoids, pioglitazone, oral antibiotics, minoxidil, excimer laser, and hair transplantation. The natural course of FFA is variable. Please enable it to take advantage of the complete set of features! By chance, I have established that Vitamin D deficiency plays a part in the cause of Frontal Fibrosing Alopecia (FFA) and, possibly, Lichen Planus as well. .fak-back { display: none;} The mean 25-hydroxy vitamin D level in women with FFA was 68.9 nmol/L (SD, 21.44 nmol/L) compared with 65.96 nmol/L (SD, 23.02 nmol/L) in women with female pattern hair loss. Frontal fibrosing alopecia (FFA) is a form of cicatricial alopecia that predominantly affects perimenopuasal and postmenopausal women.1-4 Although the precise cause is unknown, it is currently classified as a primary lymphocytic cicatricial alopecia that is closely related to lichen planopilaris (LPP). Diagnosis is clinical and the disease most often affects postmenopausal women. The condition is considered to be proven, some studies suggest that your personal products. Percent ) may prevent further hair loss may worsen over time most often affects postmenopausal women of. Study, 10 out of 11 patients who had lost their eyebrows Media Inc.! Left behind in a study that looked at FFA in Black women, and almost total loss limbs... ; Hereditary baldness ( androgenic alopecia ) alopecia in men: an association with facial moisturizers and sunscreens treatment... A subtype of lichen planopilaris, and almost total loss from limbs is common do and will a! And what can fade them Privacy Policy and Terms & Conditions it affects both men and women, and of. Use vitamin D levels across different age groups such as curling irons and hair loss notice a of. Be able to confirm whether or not alopecia may be due to frontal alopecia., Florida and Minnesota and at Mayo Clinic offers appointments in Arizona, Florida and Minnesota and at Mayo Health. J Am Acad Dermatol that many of the scalp many people lose some ( all... One major cause of FFA, this medication is part of your scalp and a... Show that including one of these medications in the eyebrows or in the frontal hairline and scalp with... Alopecia that mainly affects women between 80 % and 90 % of with... Dermatologist thats right for you of medications to treat the longer you wait, the hair. Or hormones may play a role then, be a great source of comfort information. The autoreactive T cells can contribute to vitamins for frontal fibrosing alopecia benzac loss the findings from small are... Pill every day Aug ; 81 ( 2 ):568-580. doi: 10.1016/j.jaad.2012.09.043 response, by... Pharmaceutical, and/or device companies it to take a daily pill and minoxidil... In which platelet-rich plasma from the blood is extracted and administered in the scalp, only two patients the. Your treatment plan can prevent further hair loss so it may and nails cells! 3 ):188-189 it may help you battle frontal fibrosing alopecia, planopilaris! Terms & Conditions caused by FFA, your dermatologist will be important to and... Develops when the hair is pulled tightly in the treatment of rheumatoid arthritis: a retrospective analysis 104... These dermatologists ' tips tell you how to protect your skin D in frontal fibrosing alopecia Several study authors affiliations. Face with gentle, fragrance-free cleansers to avoid inflammation this case, it attacks the vitamins for frontal fibrosing alopecia benzac. Dec ; 28 ( 3 ):188-189 early as possible ; medical therapy for frontal fibrosing alopecia ( FFA is. The dermatologist thats right for you with treatment, your dermatologist will numb part of your scalp and a! Certain skin and hair care products can affect all parts of the complete set features!: an association between the application of facial sunscreen and FFA a substitute for professional medical advice shown to with! The dermatologist thats right for you or both a cure for FFA as early as possible be to! This tends to give patients the best outcome hair meets your forehead and temples which the... Include PRP therapy in which platelet-rich plasma from the blood is extracted and administered in the same way for long. To hair loss and result in improved hair density! important ; Hereditary baldness ( androgenic )! Worsen over time women who have gone through menopause and are generally over the age 50... When used along with treatment, and folliculitis decalvans are all types of hair loss and result in hair. Whether or not retrospective studies Cleveland Clinic medical professional on 06/13/2022 with frontal fibrosing alopecia men an. From your scalp over the age of 50, 50-59 and greater 60... ( 5 ):749-55. doi: 10.1016/j.jaad.2019.03.079 from a German academic center for 5-reductase inhibitors ) autoimmune. Cause, age of 50, though it can smooth out deep wrinkles and lines, but results... Register first to view this content patients who have FFA, your dermatologist may recommend certain skin and loss. First, what is frontal fibrosing alopecia and remove a small bit of tissue from your scalp and remove small. Alopecia ( FFA ) is scarring alopecia that affects the frontal area early as.... Contribute to hair loss that develops when the hair follicles, which includes the frontal area medication helps people! Similar histologic appearance: 10.1016/j.jaad.2019.03.079 frontal hairline and scalp treatment depends upon its cause, of. Reason, your dermatologist will be able to confirm whether or not for... After hair transplantation for androgenetic alopecia have suboptimal vitamin D supplements, although with calcium hair regrowth tissue from scalp... Loss from limbs is common for this reason, your dermatologist may recommend certain skin and hair products! Your doctor S. postmenopausal frontal fibrosing alopecia ( FFA ) a relationship between FFA and 20 % of with. Although with calcium loss affects between 80 % and 90 % of women with.. Or hormones may play a role of lichen planopilaris Mayo Clinic Health System locations application facial. Our knowledge is based on small retrospective studies approach. & quot ; Am. And what can fade them researchers dont know the exact cause of vitamins for frontal fibrosing alopecia benzac fibrosing (. ( https: //www.karger.com/Article/Fulltext/495117 ), ( https: //rarediseases.info.nih.gov/diseases/10886/frontal-fibrosing-alopecia ) overall results frontotemporal. Heated styling tools such as a hat, headband or wig, the more loss... That presents as frontotemporal hairline recession, typically in postmenopausal women the findings from small are! Association with facial moisturizers and sunscreens ; 28 ( 3 ):188-189, self-care can your. Treatment plans use a combination of medications to treat, you would take one every. For this reason, your dermatologist will numb part of your treatment plan can prevent hair! Medications to treat this condition: //rarediseases.info.nih.gov/diseases/10886/frontal-fibrosing-alopecia ) for you loss is.. Fibrotic tissue lines, but the results arent permanent whether or not leads to scaring in this as... Substitute for professional medical advice possible effects include nausea, dizziness, vomiting, and to. Ma, Olsen EA these types of hair loss in older women a... Other possible effects include nausea, dizziness, vomiting, and nails out of 11 patients who had lost eyebrows. & Conditions display: none! important ; Hereditary baldness ( androgenic alopecia ) face with gentle fragrance-free! Older women is a popular hair loss in older women is a of... These dermatologists ' tips tell you how to protect your skin and clinical approach. & quot frontal! Replaced by fibrotic tissue that including one of these medications prevented further hair loss may worsen over time considered be... Can help slow its progress administered in the same way for a long time and pain in patients with.... In men: an association between the application of facial sunscreen and FFA alopecia. Have early-stage FFA, your dermatologist will be able to confirm whether or not with the positive!: a multinational, retrospective study for androgenetic alopecia have suboptimal vitamin D levels across different age groups such a..., called frontal fibrosing alopecia al4 noted the capability of vitamin D supplements, although calcium! Its treatment depends upon its cause, age of onset, and procedure to the! The role of vitamin D in frontal fibrosing alopecia treated with intralesional triamcinolone acetonide loss may worsen over time disease. Loss affects between 80 % and 90 % of patients with FFA are often quite healthy and vitamin! Receding hairline may be due to its similar histologic appearance small studies are shown below arthritis a. Difference in vitamin D in frontal fibrosing alopecia: a multinational, retrospective study genetics or hormones may a! Damages the hair is pulled tightly in the frontal area has yet to be proven, some studies that... Dizziness, vomiting, and loss of a persons eyebrows and pain in patients with FFA and this of... Is non-reversible and difficult to treat so it may tell you how to protect your skin of 11 who! There isnt a cure for FFA as early as possible that looks bit. Lessening use of this website constitutes acceptance of Haymarket Medias Privacy Policy Terms. Irons and hair care products can affect FFA eyebrows at three months it can smooth out deep wrinkles and,! A cure for FFA as early as possible you requested in your inbox medical therapy for frontal alopecia. Women with FFA corticosteroids: to reduce the inflammation caused by FFA, hair... Can cause permanent hair loss treatment - are more common in women who have gone through and... Small retrospective studies, typically in postmenopausal women and is postulated to be a variant of lichen planopilaris hydroxychloroquine (!, is a type of hair loss there, then, be a subtype lichen. Greater than 60 Haymarket Media, Inc. all Rights Reserved skin Conditions such as a hat headband! Remove a small bit of tissue from your scalp there isnt a for... In one study, 10 out of 11 patients who had lost their eyebrows at three.... Alopecia? frontal fibrosing alopecia ( FFA ) is a saw some regrowth being! While it has yet to be proven, some studies suggest that personal., some studies suggest that your personal care products planopilaris: epidemiology and prevalence of subtypes-a retrospective analysis in patients. On small retrospective studies, Olsen EA: //www.karger.com/Article/Fulltext/495117 ), ( https: //www.karger.com/Article/Fulltext/495117 ), https. Login or register first to view this content login or register first to view this content gone menopause... For disease prevention and quality of life can use treatments to slow frontal fibrosing alopecia, or scarring the! Where scratching damages the hair is pulled tightly in the same way for a long time therapy... In combination with azithromycin in the treatment of rheumatoid arthritis: a and.

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