Frontal Fibrosing Alopecia: Symptoms, Causes, Treatment

What are the symptoms of frontal fibrosing alopecia?

Frontal fibrosing alopecia (FFA) is a type of hair loss that typically affects women after menopause, though it can occur in men as well. The main symptom is hair loss along the frontal hairline and sides of the scalp. Other symptoms may include:

1. Scalp itching: Many people with FFA experience itching or burning on the scalp, which can be mild to severe.
2. Visible scalp: As hair loss progresses, the scalp may become more visible due to thinning hair.
3. Hair loss on other parts of the body: Some individuals may also experience hair loss on the eyebrows, eyelashes, or other body hair.
4. Changes in hair texture: The hair in the affected areas may become finer and less dense over time.
5. Redness or inflammation: In some cases, the affected skin may appear red or inflamed.
6. Scalp tenderness: The scalp in the affected areas may feel tender to the touch.
7. Pain or discomfort: Some individuals may experience pain or discomfort in the affected areas.

It’s important to note that the symptoms of FFA can vary from person to person, and not everyone will experience all of these symptoms. If you suspect you have FFA, it’s best to consult with a dermatologist for an accurate diagnosis and appropriate treatment.

What are the causes of frontal fibrosing alopecia?

The exact cause of frontal fibrosing alopecia (FFA) is not fully understood, but it is believed to be a combination of genetic, hormonal, and immune system factors. Some possible causes and risk factors include:

1. Genetics: There may be a genetic predisposition to developing FFA, as it tends to run in families.
2. Hormones: Changes in hormonal levels, particularly an increase in androgens (male hormones), may play a role in the development of FFA. This is supported by the fact that FFA predominantly affects postmenopausal women.
3. Autoimmunity: FFA is considered to be an autoimmune condition, where the body’s immune system mistakenly attacks the hair follicles, leading to inflammation and hair loss.
4. Environmental factors: Some researchers suggest that environmental factors, such as exposure to certain chemicals or pollutants, may trigger or exacerbate FFA in susceptible individuals.
5. Other factors: Certain medical conditions or medications may also be associated with FFA, although more research is needed to understand these potential links.

Overall, the exact cause of FFA is likely to be multifactorial, involving a combination of genetic predisposition, hormonal changes, immune system dysfunction, and possibly environmental factors.

How is the diagnosis of frontal fibrosing alopecia made?

The diagnosis of frontal fibrosing alopecia (FFA) is typically made by a dermatologist based on a combination of clinical examination, medical history, and sometimes additional tests. Here’s how the diagnosis is typically made:

1. Medical History: Your doctor will ask about your symptoms, including when they started, how they have progressed, and any other relevant medical history.
2. Physical Examination: A dermatologist will examine your scalp and hair follicles to look for signs of FFA, such as hair loss along the frontal hairline and sides of the scalp, scalp redness or inflammation, and changes in hair texture.
3. Dermoscopy: Dermoscopy is a non-invasive technique that allows the dermatologist to examine the skin and hair follicles in more detail. It can help identify characteristic signs of FFA, such as perifollicular erythema (redness around the hair follicles) and follicular hyperkeratosis (thickening of the skin around the follicles).
4. Scalp Biopsy: In some cases, a scalp biopsy may be recommended to confirm the diagnosis. During a biopsy, a small sample of skin is taken from the affected area and examined under a microscope to look for specific changes associated with FFA.
5. Blood Tests: Blood tests may be done to rule out other possible causes of hair loss, such as thyroid disorders or autoimmune conditions.
6. Other Tests: In some cases, other tests such as a trichogram (hair pull test) or a phototrichogram (hair analysis using specialized photography) may be done to assess the extent and severity of hair loss.

Based on the findings from these tests, your dermatologist can make a diagnosis of FFA and recommend appropriate treatment options. It’s important to see a dermatologist for an accurate diagnosis, as FFA can be mistaken for other types of hair loss conditions.

What is the treatment for frontal fibrosing alopecia?

Treatment for frontal fibrosing alopecia (FFA) aims to slow or stop hair loss and, in some cases, stimulate hair regrowth. The effectiveness of treatment can vary from person to person, and it’s important to discuss your options with a dermatologist. Some common treatments for FFA include:

1. Topical Corticosteroids: Topical corticosteroids are often used as first-line treatment for FFA. They help reduce inflammation and can slow the progression of hair loss. Clobetasol propionate is a commonly prescribed topical corticosteroid for FFA.
2. Topical Calcineurin Inhibitors: Drugs like tacrolimus or pimecrolimus may be used as an alternative to corticosteroids, especially in sensitive areas like the face. They work by suppressing the immune response in the skin.
3. Oral Corticosteroids: In some cases, oral corticosteroids may be prescribed for short periods to help reduce inflammation and halt hair loss. However, long-term use of oral corticosteroids is generally not recommended due to the risk of side effects.
4. Topical or Oral Minoxidil: Minoxidil is a medication that can help stimulate hair regrowth. It is available as a topical solution or foam, and in some cases, oral minoxidil may be prescribed.
5. Doxycycline: Some studies suggest that doxycycline, an antibiotic with anti-inflammatory properties, may help reduce inflammation and improve hair regrowth in FFA.
6. Intralesional Corticosteroid Injections: Injections of corticosteroids directly into the affected areas of the scalp may be used in cases where topical treatments are not effective.
7. Hormone Therapy: In postmenopausal women with FFA, hormone therapy with drugs like finasteride or dutasteride may be considered to help block the effects of androgens on the hair follicles.
8. Surgical Hair Restoration: In some cases, surgical options such as hair transplantation may be considered to restore hair in areas of significant hair loss.
9. Cosmetic Camouflage: Hair loss from FFA can be distressing, and using wigs, hairpieces, or hair styling techniques can help improve the appearance of thinning hair.

It’s important to work closely with a dermatologist to monitor your condition and adjust your treatment plan as needed. FFA can be a challenging condition to treat, and finding the right combination of treatments may require some trial and error.