Frontal Fibrosing Alopecia: An Update

Area of Science:

• Dermatology
• Pathology
• Genetics

Background:

• Frontal fibrosing alopecia (FFA) has seen a significant rise in prevalence since 1994.
• Familial cases suggest a genetic predisposition, while epidemiological data points to environmental triggers.

Purpose of the Study:

• To review recent advancements in understanding FFA's etiology, pathology, and treatment.
• To highlight the ongoing search for causal links between environmental factors and FFA.

Main Methods:

• Review of genetic studies confirming inherited predisposition.
• Analysis of epidemiological data implicating environmental factors like skincare products and exogenous estrogens.
• Clarification of pathological mechanisms, including inflammation and epithelial-mesenchymal transition.

Main Results:

• Genetic predisposition to FFA is confirmed.
• Environmental factors, particularly personal care products and UV filters, are suspected but not definitively linked.
• Pathological mechanisms involve inflammatory components, loss of follicular immune privilege, and epithelial-mesenchymal transition.

Conclusions:

• FFA likely involves both genetic and environmental factors.
• Lichen planus pigmentosus may be part of the same pathology, offering etiological clues.
• Early diagnosis and novel treatments, including Janus kinase inhibitors, are key for managing FFA progression.