What are the other Names for this Condition? (Also known as/Synonyms)

• FFA (Frontal Fibrosing Alopecia)
• Patterned Lichen Planopilaris of the Scalp
• Postmenopausal Frontal Fibrosing Alopecia

What is Frontal Fibrosing Alopecia? (Definition/Background Information)

• Frontal Fibrosing Alopecia (FFA) is form of scarring alopecia that is also presents loss of hair on other parts of the body. The exact cause of the condition is unknown but is believed to arise from hormonal, inflammatory, environmental, and genetic factors. FFA is a subtype of lichen planopilaris
• The treatment of Frontal Fibrosing Alopecia may involve oral steroids, anti-inflammatory medications, and surgical procedures, if required. However, the condition is generally incurable, even though in many individuals, the progression of the condition may stabilize over time. The hair loss is usually permanent

Who gets Frontal Fibrosing Alopecia? (Age and Sex Distribution)

• Frontal Fibrosing Alopecia is a relatively new disorder that is known to affect individuals of all age groups
• Both males and females are affected, although some reports indicate a female predominance
• Worldwide, individuals of all racial and ethnic groups are affected, and no predilection is noted

What are the Risk Factors for Frontal Fibrosing Alopecia? (Predisposing Factors)

The risk factors for Frontal Fibrosing Alopecia may include:

• Female gender, generally age over 50 years, particularly in the post-menopausal stage of life
• Use of “leave-on” facial creams with sunscreen chemicals in them has been suggested
• Contact allergy to fragrances and perfumes
• Thyroid disease such as hypothyroidism
• Autoimmune diseases such as systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA)
• Very rarely, a family history of the condition

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Frontal Fibrosing Alopecia? (Etiology)

Presently, the exact cause of development of Frontal Fibrosing Alopecia (FFA) is not well-understood. It is described as a subtype of lichen planopilaris.

• FFA was first reported in 1997; it is now a frequently reported condition
• It has been suggested that a combination of genetic, environmental, and hormonal factors may play a role in the development of the disorder
• Some research experts believe that it is an autoimmune disorder that targets the hair follicles
• In one study, an association between long-term use of cosmetics with sunscreen chemicals and FFA has been suggested
• An association with thyroid disease has also been found with FFA in the same study

What are the Signs and Symptoms of Frontal Fibrosing Alopecia?

The signs and symptoms of Frontal Fibrosing Alopecia may vary among the affected individuals in type and severity. It may include:

• Reddish discoloration is seen around the hair before hair loss occurs
• Hair loss that is symmetrical and uniformly observed along the front and sides. This appears as a receding hair line
• Initially, the affected areas may present pain, itchiness, and even facial rashes
• The bald areas may show few stray hairs
• FFA is classified as a “scarring alopecia”. It does not show signs of a typical scar. “Scarring” refers to the destruction of the hair follicles, and the permanence of hair loss
• The hair loss area appears shiny because of the absence of tiny open follicles
• Sometimes, the hair loss pattern may be irregular or zigzag
• Hair thinning or hair loss may be noticed on other areas of the body such as the eyebrows, eyelashes, face, and limbs. This may occur even before the scalp hair disappears
• In men, beard thinning and loss of hair from the sideburns is also noted

How is Frontal Fibrosing Alopecia Diagnosed?

Frontal Fibrosing Alopecia is diagnosed on the basis of the following information:

• Physical examination of the individual and medical history evaluation
• Assessment of symptoms and visual inspection of the affected region
• Blood tests including thyroid function test
• Assessment of hormone status
• Dermoscopy: Dermoscopy is a diagnostic tool where a dermatologist examines the skin using a special magnified lens
• Wood’s lamp examination: In this procedure, the healthcare provider examines the skin using ultraviolet light. It is performed to examine the change in skin pigmentation
• Skin patch testing
• Skin biopsy, is necessary for the diagnosis of FFA: A skin biopsy is performed and sent to a laboratory for a pathological examination. The pathologist examines the biopsy under a microscope. After putting together clinical findings, special studies on tissues (if needed) and with microscope findings, the pathologist arrives at a definitive diagnosis

A differential diagnosis may be necessary to eliminate other conditions that present similar signs and symptoms. This may include:

• Lichen planopilaris
• Traction alopecia
• Other conditions causing scarring hair loss

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Frontal Fibrosing Alopecia?

The complications of Frontal Fibrosing Alopecia may include:

• Anxiety and depression
• Low self-esteem and social self-isolation
• Permanent hair loss
• Swelling of ankles and weight gain due to medications

Complications may occur with or without treatment, and in some cases, due to treatment also.

How is Frontal Fibrosing Alopecia Treated?

There is currently no cure for Frontal Fibrosing Alopecia. However, the healthcare provider may consider the following treatments:

• Anti-inflammatory ointments or medications (such as corticosteroids, doxycycline, or hydroxychloroquine)
• Medications that block the production of the male hormone 5-alpha reductase. These can only be used in males or females who cannot become pregnant
• Administration of immunosuppressants
• Intralesional injection of medication
• Off-label prescription of pioglitazone, which is generally used for diabetes
• Hair grafting, if necessary

Regular medical screening at periodic intervals with tests and physical examinations are recommended.

How can Frontal Fibrosing Alopecia be Prevented?

It may not be possible to prevent all cases of Frontal Fibrosing Alopecia. However, in some cases, the following measures may be considered:

• Minimizing sun exposure; use of wide-brimmed hats
• Taking adequate treatment of autoimmune conditions or thyroid diseases
• Minimizing exposure to fragrances that can cause contact allergic dermatitis

If Frontal Fibrosing Alopecia runs in the family, it may not be preventable since it is a genetic disorder.

What is the Prognosis of Frontal Fibrosing Alopecia? (Outcomes/Resolutions)

• The prognosis of Frontal Fibrosing Alopecia varies among affected individuals, but it may be self-limiting in many cases
• Also, in many FFA is a slowly progressive disorder; the condition stabilizes over time, with hair regrowth reported in some of the affected individuals
• The effect of medications used for treatment is reported to vary among the affected individuals

Additional and Relevant Useful Information for Frontal Fibrosing Alopecia:

The following DoveMed website link is a useful resource for additional information:

https://www.dovemed.com/healthy-living/skin-disorders/