Frontal Fibrosing Alopecia: A Comprehensive Review with Recent Updates

Shikha Verma ¹, Anita Marak ¹, Debopriya Paul ²

⁰From the Department of Dermatology, NEIGRIHMS, Meghalaya, Bihar, India.

Indian Journal of Dermatology +

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March 31, 2025

View abstract on PubMed

Summary

Frontal fibrosing alopecia (FFA) is a progressive scarring hair loss condition in postmenopausal women. Research explores its causes, including genetics and immune factors, and evaluates treatments like biological agents.

Area Of Science

Dermatology
Trichology
Pathology

Background

Frontal fibrosing alopecia (FFA) is a primary lymphocytic scarring alopecia, often considered a variant of lichen planopilaris (LPP).
Its exact cause is unknown, but genetic, autoimmune, hormonal, and environmental factors are implicated.
The condition involves hairline recession, shiny atrophic skin, and characteristic histopathological findings.

Purpose Of The Study

To summarize the current understanding of frontal fibrosing alopecia (FFA).
To discuss the potential etiopathogenesis, clinical and trichoscopic findings, and diagnostic criteria for FFA.
To review available and emerging treatment options for FFA.

Main Methods

Review of existing literature on frontal fibrosing alopecia.
Analysis of clinical, trichoscopic, and histopathological features.
Evaluation of proposed diagnostic criteria and treatment outcomes.

Main Results

FFA presents with frontal and temporoparietal hairline recession and characteristic trichoscopic and histopathological signs.
Diagnostic criteria by Tolkachjov et al. and the International FFA Cooperative Group are available.
Current treatments offer limited satisfactory results, prompting investigation into newer agents.

Conclusions

Frontal fibrosing alopecia is a distinct scarring alopecia with complex potential causes.
Accurate diagnosis relies on clinical, trichoscopic, and histopathological evaluation.
Novel treatments, including biological agents like tofacitinib and tildrakizumab, show promise for managing FFA.

Keywords:

FFA Frontal fibrosing alopecia lichen planopilaris postmenopausal women scarring alopecia