Frontal Fibrosing Alopecia

Condition Name: Frontal fibrosing alopecia (FFA)

Definition: Frontal fibrosing alopecia (FFA) is a type of cicatricial (scarring) alopecia characterized by the progressive recession of the frontal hairline and often the eyebrows.

Etiology: The etiology of FFA remains unclear, though hormonal, genetic, and environmental factors are believed to contribute. It is considered a variant of lichen planopilaris, an inflammatory condition that results in scarring hair loss.

Epidemiology: FFA predominantly affects postmenopausal women, though it can also occur in men and younger women. It has been increasingly recognized since its initial description in the 1990s, with rising incidence rates suggesting either a true increase in prevalence or better recognition by clinicians. It primarily affects women over the age of 50, but cases in younger women and men have been reported.

Signs: The symmetrical recession of the frontal hairline, is often accompanied by perifollicular erythema and follicular hyperkeratosis. Loss of eyebrows and, less commonly, body hair can also occur.

Symptoms: Patients may experience pruritus and a sensation of tightness in the scalp, in addition to hair loss.

Differentials: Conditions such as lichen planopilaris, traction alopecia, and alopecia areata should be considered.

Diagnosis: Diagnosis is based on clinical examination, and patient history, and may include a scalp biopsy to confirm the presence of scarring and inflammation around hair follicles.

Treatment: Treatment aims to halt the progression of hair loss and reduce symptoms. Common therapeutic approaches include topical and intralesional corticosteroids, oral antimalarials like hydroxychloroquine, and systemic anti-inflammatory medications such as doxycycline and finasteride. Early diagnosis and intervention are crucial for effective management.

References:

●       Tziotzios, C., Stefanato, C. M., Fenton, D. A., & McGrath, J. A. (2015). Frontal fibrosing alopecia: Reflections and hypotheses on aetiology and pathogenesis. Experimental Dermatology, 25(3), 847-852. doi:10.1111/exd.13061

●       Kossard, S., Lee, M. S., Wilkinson, B., & Kossard, D. (2020). “Frontal fibrosing alopecia: A review of 60 cases.” Journal of the American Academy of Dermatology, 83(4), 1105-1112. doi:10.1016/j.jaad.2020.04.007