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Frontal Fibrosing Alopecia - Causes, Clinical Presentation, and Treatment

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Frontal fibrosing alopecia is a pattern of hair loss affecting the front and sides of the scalp, present mainly in females over 50 years of age.

Written by

Dr. Neha Rani

Medically reviewed by

Dr. Sandhya Narayanan Kutty

Published At April 18, 2023
Reviewed AtApril 18, 2023

What Is Frontal Fibrosing Alopecia?

A variant of lichen planopilaris known as frontal fibrosing alopecia (FFA) is characterized by gradually progressing baldness and scarring on the scalp near the forehead. Frontal fibrosing alopecia (FFA) presents as hair loss on the front and sides of the scalp. It can also influences the hair present on the body in other places, most frequently the eyebrows. In some circumstances, the eyebrows, eyelashes, or hair present on different body parts may also be affected. The specific cause of frontal fibrosing alopecia is still unknown, despite theories that it can be brought on by hormone changes or is an immunological reaction. A receding hairline that extends along the front and sides of the head is a common symptom of this type of hair loss.

The frontotemporal zone of the scalp exhibits band-like cicatricial alopecia as its defining feature. At the edge of the hairy area, there can be indications of perifollicular inflammation. In addition to the possibility of axillary, pubic, facial, and limb hairy lesions being present, alopecia of the eyebrows is commonly related. A lymphocytic infiltrate is visible on histopathological analysis surrounding the isthmus and infundibulum, along with a reduction in the number of follicles replaced by fibrosis. It most frequently affects women after menopause and affects the frontal region. The recognition of familial situations is a recent development, as is their description in humans.

What Causes Frontal Fibrosing Alopecia?

The cause of the condition is unknown. However, the below-mentioned reasons are considered to be causes of frontal fibrosing alopecia.

  • Autoimmune Disease - In an autoimmune condition, the immune system assaults the follicles that produce hair (hair follicles). Lichen planus, an autoimmune disorder, results in scalp inflammation and scarring (lichen planopilaris).

  • Genetics - Frontal fibrosing alopecia cases are being reported in families; hence, genetics is considered one of the reasons for the occurrence of FFA.

  • Hormones - It is suggested that hormones can be a reason for frontal fibrosing alopecia since it is most commonly reported in post-menopausal women.

  • Surgery - Hair transplant and facelift treatment are seen to be associated with frontal fibrosing alopecia.

Environmental factors are also believed to play a role in triggering this disease. A few of the elements are listed below:

  • Exposure to the sun.

  • Dioxin (organic pollutants) are substances that are present in animal food.

  • Viral infections.

What Is the Clinical Presentation of Frontal Fibrosing Alopecia?

  • Hair Loss From the Scalp - The most predominant symptom of frontal fibrosing alopecia is hair loss along the front and sides of the hairline. The baldness begins gradually but gets worse with time. The skin might appear normal but can also appear pale, scarred, and shiny.

  • Loss of Eyebrows - Loss of eyebrows is mainly seen in females and can occur before hair loss in the scalp region.

The other symptoms that may be seen during the early stages of the disease include:

  • The face and neck may have flat, dark brown, or gray patches of skin (hyperpigmentation).

  • Pain on the scalp or itchy skin.

  • Large veins appear on the forehead.

  • Small yellow or skin-colored bumps are present that appear like pimples near the hairline or on the face and scalp.

The less common symptoms that appear with this condition are:

  • Hair loss in the pubic region.

  • Hair loss from the eyelashes.

  • Hair loss from the underarms and face.

  • Hair loss from the arms and legs.

How Is Frontal Fibrosing Alopecia Treated?

In frontal fibrosing alopecia, no treatment has been demonstrated to be productive. Before establishing the effectiveness of a therapy, caution should be exercised due to the lack of controlled trials and the possibility of frontal fibrosing alopecia being spontaneously stabilized. There are no established standards for evaluating the efficacy of frontal fibrosing alopecia therapies. The measurements between the frontotemporal line and the glabella or the number of hairs would be the most scientifically accurate criteria. Since no definite treatment indications exist, the doctor suggests a combination of drugs to treat the symptoms effectively.

  • Minoxidil - Minoxidil is a drug that is applied on the scalp. It may help improve hair loss when combined with another medicine, such as Finasteride or corticosteroids. It is effective only in cases associated with androgenic alopecia (baldness pattern in males).

  • Hydroxychloroquine - It is a drug that lessens discomfort and itching signs and symptoms. Research indicates that if taken at an early stage, it might also aid in some hair regrowth; however, it is often ineffective.

  • Dutasteride or Finasteride - These drugs are administered as a tablet to stop further hair loss.

  • Corticosteroids - They can be injected or used topically at home. They can help prevent further hair loss. Intralesional corticosteroids are more effective. It is most effective on the hair or eyebrows. The use can worsen atrophy.

  • Antibiotics - Doxycycline and Minocycline are administered to prevent and reduce inflammation and, thus, treating hair loss.

  • Laser Therapy - It can help in decreasing itchiness and swelling.

  • Hair Grafts - It is helpful as it aids in hair growth once the disease progression has decreased or has halted.

What Is the Prognosis of Frontal Fibrosing Alopecia?

Half of the scalp might be affected by alopecia (crown alopecia). Prior to stabilization, the final result of the severity of alopecia is impossible to predict. In the case of frontal fibrosing alopecia treatment and therapy, hair loss slows over time; however, the lost hair typically does not grow back.

Conclusion

Band-like hair loss at the hairline and on the sides is a typical feature of frontal fibrosing alopecia (FFA). At the edge of the hairy area, there can be indications of perifollicular inflammation. Hair loss is also seen on the eyebrows, eyelashes, and other body parts. Even though the disorder has no specific treatment, a dermatologist should be consulted about managing the condition. Dermatology nurses support patient care by educating patients, keeping track of their progress, and reporting to the dermatologist. Pharmacists assist in looking for interactions and inform patients about potential side effects while reviewing prescribed medications. Patients with frontal fibrosing alopecia generally have poor results because they experience significant hair loss.

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Dr. Sandhya Narayanan Kutty
Dr. Sandhya Narayanan Kutty

Venereology

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