FRONTAL FIBROSING ALOPECIA (FFA)
Q: WHAT IS FRONTAL FIBROSING ALOPECIA?
Frontal Fibrosing alopecia (FFA) is a form of scarring hair loss affecting the hair margin on the front of the scalp. This happens due to inflammation and destruction of the hair follicles. There may also be hair loss from the scalp near the ears and from the eyebrows. Hair loss can also occur from other body parts, which is less common. FFA occurs mainly in white postmenopausal women but can occur in premenopausal women, men, and people of other ethnicities. Frontal fibrosing alopecia is thought to be a variant of another condition called lichen planopilaris.
Frontal fibrosing alopecia is a variety of cicatricial alopecia characterised by a band of frontal/ frontoparietal hair recession and marked decrease or a complete loss of the eyebrows, typically observed in postmenopausal women.
KEY STATS:
The number of patients with FFA seen has increased over the last decade. In one study, FFA was presented in Caucasian women with significantly above-average affluence scores and were less likely to be smokers. The mean age at presentation was 64 years, and the average disease duration was 3.4 years (6 months-30 years). Three patients were premenopausal.
Q: WHO GETS FRONTAL FIBROSISNG ALOPECIA? WHO IS AT MOST RISK?
FFA occurs mainly in white postmenopausal women but can occur in premenopausal women, men, and people of other ethnicities. One study shows that the women affected were all white, and 95% were postmenopausal.
Q: WHAT CAUSES FRONTAL FIBROSING ALOPECIA?
The exact cause of FFA remains to a degree enigmatic, but what is known is that it is categorised as an inflammatory condition causing permanent scarring to the areas of the scalp affected, cells, called lymphocytes, that are part of the body’s immune system attack the hair follicles. Inflammatory, genetic, autoimmune and environmental factors are all thought to have a role in the onset of FFA.
Q: WHAT ARE THE PRESENTING SYMPTOMS?
Frontal fibrosing alopecia causes the frontal hairline to recede progressively over time. The rate of hair loss tends to vary from person to person. There can be some redness and flaky skin around individual hairs. Once a hair has fallen out, it will not re-grow in this area. The skin left behind may appear slightly paler and smoother than the rest of the skin on the forehead. In addition, some patients may lose hair from eyebrows and other body parts.
Q: HOW DOES IT AFFECT YOUR HEALTH?
Frontal fibrosing alopecia may cause no symptoms at all or may cause an itchy, painful or burning sensation in a band across the frontal hairline. Many people find the experience of hair loss to be distressing.
Q: HOW IS IT DIAGNOSED?
The clinical features of frontal fibrosing alopecia are particularly distinctive, presenting hair loss along the frontal, frontotemporal, or temporal scalp associated with scarring of the scalp tissue.
Also, a common loss of eyebrows is associated with scarring of the skin tissue of the eyebrow area. Loss of areas of body hair can also be characteristic of FFA.
Erythema and scaling can be seen around the hair follicles, and isolated hair can often be seen along the affected hairlines.
Q: WHAT IS THE PROGNOSIS?
If FFA remains untreated, the area’s cicatricial (scarring) damage will likely gradually spread, and more hair loss will be experienced. FFA can burn itself out over several years, and the spread of skin damage and hair loss will stop. The recession through the affected hair lines can be between 2 to 3cm, and the hair loss is permanent in the regions of scarring.
Q: WHAT TYPES OF TREATMENT IS AVAILABLE? HOW DO YOU PREVENT [CONDITION]? WHAT CAN I DO TO CONTROL MY SYMPTOMS?
Treatment for FFA will be through dermatology, and topical and/ or intralesional steroids or immunosuppressant medications can be administered as a treatment pathway.
JULY 2023