Frontal Fibrosing Alopecia.

Area of Science:

• Dermatology
• Trichology
• Hair Biology

Background:

• Frontal fibrosing alopecia (FFA) is a primary scarring alopecia identified just over two decades ago.
• It is now a common diagnosis in specialist hair loss clinics, often considered a variant of lichen planopilaris (LPP).
• FFA typically affects postmenopausal women but is increasingly observed in men and premenopausal women, with expanding clinical presentations.

Purpose of the Study:

• To review the distinct clinical features, associations, and evolving spectrum of frontal fibrosing alopecia.
• To discuss the potential genetic and environmental factors implicated in FFA etiology.
• To summarize current management strategies and highlight the need for clinical trials to confirm treatment efficacy.

Main Methods:

• Literature review of clinical studies and case reports on frontal fibrosing alopecia.
• Analysis of distinct clinical features differentiating FFA from lichen planopilaris.
• Synthesis of information on demographic trends, disease progression, and treatment outcomes.

Main Results:

• FFA presents unique characteristics distinguishing it from LPP.
• The condition's prevalence is increasing, affecting a broader demographic including men and premenopausal women.
• FFA's clinical scope has broadened from the frontal hairline and eyebrows to potentially encompass the entire scalp and body hair.

Conclusions:

• Frontal fibrosing alopecia is a significant and growing cause of scarring alopecia with a diverse clinical presentation.
• The etiology of FFA remains unclear, with suspected genetic and environmental influences.
• Evidence-based treatment guidelines are lacking, necessitating further clinical trials to establish effective management strategies.