[Frontal fibrosing alopecia]

Area of Science:

• Dermatology
• Trichology

Background:

• Frontal fibrosing alopecia (FFA) is a cicatricial alopecia, initially described as a variant of lichen planopilaris (LPP).
• Histopathological findings of FFA and LPP are identical, making classification based solely on histology challenging.
• FFA exhibits a characteristic clinical presentation, particularly in postmenopausal women.

Purpose of the Study:

• To summarize the clinical characteristics, potential etiologies, and current treatment strategies for frontal fibrosing alopecia (FFA).
• To differentiate FFA from lichen planopilaris (LPP) based on clinical presentation despite identical histopathology.

Main Methods:

• Review of existing literature on frontal fibrosing alopecia (FFA) and lichen planopilaris (LPP).
• Analysis of clinical descriptions, histopathological findings, and treatment outcomes reported for FFA.
• Discussion of proposed etiological factors and pathogenetic mechanisms.

Main Results:

• FFA typically presents as a band-like frontotemporal hairline recession with perifollicular erythema and papules.
• Eyebrow loss is common in FFA patients; rare cases show involvement of extremities.
• Histopathology is indistinguishable from lichen planopilaris (LPP).

Conclusions:

• Frontal fibrosing alopecia (FFA) is clinically distinct from lichen planopilaris (LPP), despite shared histopathology.
• The etiology and pathogenesis of FFA remain unclear, with proposed factors including hormonal influences, genetics, and autoimmune responses.
• Treatment for FFA is challenging; current options primarily address follicular inflammation, as skin atrophy is irreversible.