Frontal Fibrosing Alopecia: A Comprehensive Review with Recent Updates

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.