Frontal Fibrosing Alopecia: Causes and Treatment

The information about alopecia is often varied and extensive, although frontal fibrosing alopecia is one of the conditions that took the longest to be described. The first time a doctor produced a precise report identifying it as a variant of scarring alopecia was in 1994 by Dr. Kossard. It is characterized by hair loss and scarring in the frontal region of the scalp, right at the hairline.

Characteristics

It generally affects postmenopausal women, around 50 years of age, and is characterized by causing, in addition to hair loss, the creation of a symmetrical band in the frontal part of the scalp, also covering the sides of the head. Occasionally, frontal fibrosing alopecia causes loss of eyebrows and body hair. In some cases, isolated hairs in scarred areas have been described.

The visual characteristics of FFA show the affected area as pale and shiny, similar to other tissues that have healed from deep wounds. If the area is observed closely, scaly areas with pronounced redness around the hair follicles can be detailed.

As it progresses and its effects are not corrected, the affected person notices a progression of symmetrical hair loss on both sides of the head. This advances inward over time if treatment is not started. In the initial stages, hair loss is two to three centimeters, and when the disease progresses, it can reach a depth of 10 centimeters.

The disappearance of body hair is also found in the disease lichen planopilaris, which is closely related to frontal fibrosing alopecia in women. They may have symptoms of female pattern baldness.

Causes of Frontal Fibrosing Alopecia

The causes are unknown. Currently, numerous studies have tried to find an origin or causes of frontal fibrosing alopecia. As of the writing of this article, they remain unknown. However, it is known to be an immune system response to an unknown origin. In response, the scalp inflames and scars the hair follicles, resulting in imminent hair loss. The onset of the condition after menopause shows indications of its hormonal origin, although, as we indicate in the article, the unequivocal causes that stimulate its appearance have yet to be described.

Frontal fibrosing alopecia is considered a variant of lichen planus. See info. Another related hair pathology is Brocq’s pseudopelade, originally described by Louis Anne Jean Brocq as a type of scarring alopecia.

Diagnosis and Prognosis

To ensure that the hair loss pattern and condition correspond to frontal fibrosing alopecia, a scalp skin biopsy is performed. The person with frontal baldness allows the extraction of hair follicles to be analyzed in the laboratory. If the hair follicles are affected by a lichenoid pattern with inflammation and scarring, the result is positive. The characteristics of the diseased tissues do not differ from those affected by lichen planopilaris.

Generally, the progression of FFA is slow but progressive. In some patients, symptoms stabilize after a few years.

Treatment for Frontal Fibrosing Alopecia

Since the exact causes are still to be described, it is challenging to indicate a treatment for fibrosing alopecia that is unique and exclusive. Patients with this condition are administered a cocktail of oral steroids, anti-inflammatory drugs for the hair follicles, and tetracycline-type antibiotics that combat microbial agents. In some cases, the use of antimalarial drugs is advised, as there are studies indicating benefits in patients showing rapid hair loss at the onset of the disease.

Other treatments for frontal fibrosing alopecia are 5-alpha reductase finasteride and dutasteride. Products indicated to stop hair loss in women and men.

It is common for it to mostly affect women over forty years old, although there are also cases in young people and men.

Permanent Solution

We have mentioned that there are drug-based treatments, but these unfortunately almost always come with unpleasant side effects. Instead, hair grafting is a permanent alternative that can solve aesthetic problems. This process improves appearance and helps to gain confidence.