Frontal Fibrosing Alopecia

Is a rare chronic progressive primary scarring alopecia. FFA is a clinical variant of lichen planopilaris.  It presents with the progressive recession/ smooth balding of the frontal and temporal hairline. It can also be associated with eyebrow and body hair loss, and facial bumps and dark marks.  FFA is seen more commonly in postmenopausal Caucasian women but upwards of 12% of FFA cases occur in women of African descent (majority premenopausal).  The exact cause of FFA is unknown.  However, some proposed mechanisms include genetic predisposition (HLA-B*07:02 allele), autoimmune dysfunction, decreased levels of androgens, reduction in peroxisome proliferator-activated receptor gamma (PPAR-γ), and possible environmental exposures.  Management includes anti-androgen (i.e finasteride), anti-inflammatories (i.e. steroids, oral tetracyclines, oral antimalarials, other immunosuppressants), minoxidil, retinoids, and scalp camouflage. There have been limited case reports using platelet rich plasma and one should use caution with hair transplantation as reactivation of the disease may occur. 

 

References

- Strazzulla LC et al.  Prognosis, treatment, and disease outcomes in frontal fibrosing alopecia: A retrospective review of 92 cases.  J Am Acad Dermatol. 2018 Jan;78(1):203-205​

- Murad A, Bergfeld W.  5-alpha-reductase inhibitor treatment for frontal fibrosing alopecia: an evidence-based treatment update.  J Eur Acad Dermatol Venereol. 2018 Mar 10.​

- Tziotzios C. et al. Genome-wide association study in frontal fibrosing alopecia identifies four susceptibility loci including HLA-B*07:0. Nat Commun. 2019 Mar 8;10(1):1150

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