Frontal Fibrosing Alopecia: Causes and treatment Guide

Causes of Frontal Fibrosing Alopecia

Understanding the potential triggers of FFA is crucial for both patients and healthcare providers. Various factors may contribute to the onset of Frontal Fibrosing Alopecia:

1. Genetic Factors: Research suggests that genetic predisposition plays a role in FFA, with familial occurrences noted in some cases. However, the exact hereditary patterns are not clearly defined, and most cases are not directly inherited.

2. Hormonal Influences: FFA predominantly affects women, especially after menopause, suggesting that hormonal shifts, particularly the decline in oestrogen, may influence the condition. Interestingly, hormonal therapies do not appear to have an effect on the progression of FFA.

3. Autoimmune Disorders: There is a notable correlation between FFA and autoimmune diseases. Studies have indicated that a significant percentage of patients with FFA also have other autoimmune conditions, such as lupus, thyroid disorders, or psoriasis, which may suggest a shared pathological mechanism.

4. Environmental Factors: External factors, including the use of certain cosmetic products, environmental toxins, and stress, may also play a role in the development of FFA. The increasing use of facial products, particularly those containing potential irritants, has been implicated in some studies.

Risk Factors for Frontal Fibrosing Alopecia

While anyone can develop FFA, certain demographics are more commonly affected:

• Gender and Age: The condition is predominantly seen in women, particularly those aged between 55 and 63, coinciding with postmenopausal changes. However, men can also experience FFA, albeit less frequently.

• Ethnicity: Some studies have shown that women of African descent may present symptoms earlier and may be more susceptible to traction alopecia, which can overlap with the presentation of FFA.

Symptoms of Frontal Fibrosing Alopecia

The symptoms of Frontal Fibrosing Alopecia can vary in intensity and manifestation, making early recognition essential for effective management. Key symptoms include:

• Receding Hairline: The hallmark of FFA is a progressive recession of the frontal hairline, often described as a band-like pattern.

• Eyebrow and Body Hair Loss: Many individuals with FFA experience significant thinning or complete loss of their eyebrows and, in some cases, body hair.

• Perifollicular Erythema: Early signs may include redness and scaling around the hair follicles at the hairline, indicating inflammation.

• Scarring and Skin Changes: As the condition progresses, the skin in affected areas may appear pale, shiny, and scarred due to the loss of hair follicles.

• Associated Symptoms: Patients may also report itchiness, pain, or discomfort in the affected areas. In some instances, facial papules or changes in skin pigmentation may occur.

Diagnosing Frontal Fibrosing Alopecia

Diagnosis of Frontal Fibrosing Alopecia typically involves a combination of patient history, physical examination, and potentially laboratory tests. Key diagnostic steps include:

• Medical History: A thorough assessment of the patient's symptoms, duration of hair loss, and any associated medical conditions is essential.

• Physical Examination: A close examination of the scalp, hairline, and any other affected areas helps identify the characteristic patterns of hair loss.

• Dermoscopy: This non-invasive technique allows the clinician to examine the scalp's surface closely, identifying changes in the hair follicles and surrounding skin.

• Scalp Biopsy: In some cases, a scalp biopsy may be necessary to confirm the diagnosis and rule out other conditions. This involves removing a small sample of scalp tissue for microscopic analysis.

Treatment Options for Frontal Fibrosing Alopecia

While there is currently no cure for Frontal Fibrosing Alopecia, several treatment options are available to manage symptoms and slow disease progression. Treatment efficacy can vary among individuals, and a tailored approach is often required.

1. Topical Minoxidil: Commonly used for androgenetic alopecia, minoxidil may help promote hair growth in areas affected by FFA. It works by increasing blood flow to the hair follicles and prolonging the growth phase of hair.

2. Topical Corticosteroids: These can help reduce inflammation and itching associated with FFA. They may be applied directly to the affected areas to alleviate symptoms.

3. Intralesional Steroid Injections: For localized inflammation, corticosteroids can be injected directly into the affected scalp areas to reduce immune-mediated damage.

4. Immunosuppressive Therapies: Medications like mycophenolate mofetil and hydroxychloroquine can be used to modulate the immune response in patients with autoimmune components to their FFA.

5. 5-alpha-Reductase Inhibitors: Drugs like finasteride and dutasteride, commonly used for male and female pattern baldness, may be beneficial in preventing further hair loss by blocking the conversion of testosterone to dihydrotestosterone (DHT), although their efficacy specifically for FFA requires more research.

6. Antibiotics: Tetracycline antibiotics can help reduce inflammation and are sometimes prescribed for patients with concurrent skin conditions.

7. Hair Transplant Surgery: While hair transplant surgery is not typically the first line of treatment, it may be considered for patients with stable FFA who have not responded to other treatments. The success of hair transplants in FFA can be variable, and thorough evaluation is necessary to determine candidacy. We usually do not recommendi transplant surgery - of the last 3 hair transplants we have performed on patients with this condition we have seen 2 out of 3 fail.

8. Laser Therapy: Low-level laser therapy may be beneficial for some patients, promoting blood circulation and potentially stimulating hair growth.