Frontal fibrosing alopecia

Frontal fibrosing alopecia (FFA) is a form of scarring (cicatricial) alopecia that primarily affects the frontal and temporal hairline, causing progressive and permanent hair loss in a band-like pattern along the front and sides of the scalp. It is considered a clinical variant of lichen planopilaris (LPP), a condition in which chronic inflammation destroys hair follicles and replaces them with scar tissue. FFA predominantly affects postmenopausal women, though it can also occur in premenopausal women and, rarely, in men. The condition was first described in 1994 and appears to be increasing in prevalence, though the reasons for this are not fully understood. Key clinical features include recession of the frontotemporal hairline, loss of eyebrows (often preceding scalp hair loss), and loss of body hair in many cases. The skin in affected areas may appear pale or slightly scarred. Some patients also develop facial papules, particularly on the forehead and temples, which represent involvement of vellus hair follicles. Lichen planus pigmentosus, a hyperpigmentation of the face and neck, may co-occur. The disease can also affect the occipital hairline and sideburn areas. Patients may experience mild itching, burning, or tenderness at the hairline, though many are asymptomatic aside from the cosmetic changes. The exact cause of FFA remains unclear, but it is thought to involve an autoimmune-mediated inflammatory process targeting the hair follicle. Genetic susceptibility factors have been identified, and environmental triggers such as sunscreen use and certain cosmetic products have been investigated, though definitive causation has not been established. Treatment aims to slow or halt disease progression, as lost hair cannot regrow once scarring has occurred. Commonly used therapies include 5-alpha reductase inhibitors (such as finasteride or dutasteride), hydroxychloroquine, topical or intralesional corticosteroids, and topical calcineurin inhibitors such as tacrolimus. No single treatment has been proven universally effective, and management is individualized based on disease activity and patient response.

Data sourced from FDA regulatory filings and ClinicalTrials.gov. Updated periodically.

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