Frontal Fibrosing Alopecia: Everything You Need to Know

Elisa Chistyukhina

Elisa Chistyukhina

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What is frontal fibrosing alopecia?

Frontal fibrosing alopecia (FFA) is a type of scarring alopecia that affects the frontal hairline and scalp. It is characterized by the progressive shrinking and thinning of hair follicles, leading to hair loss and a distinctive band of hair loss along the forehead and temples. The condition is also known as lichen planopilaris (LPP) or lymphocytic cicatricial alopecia (LCA).

FFA is a chronic condition that can affect both men and women of any age, but it is more commonly seen in postmenopausal women. It is believed to be an autoimmune disease, where the body’s immune system mistakenly attacks the hair follicles, leading to inflammation and scarring. The exact cause of FFA is not yet fully understood, but researchers believe that a combination of genetic, hormonal, and environmental factors may play a role in its development.

Prevalence and incidence of FFA

The exact prevalence of FFA is not well-established, but it is estimated to affect around 1 in 1000 individuals. Studies have shown that the condition is more common in women than men, with a female-to-male ratio of 3:1. The majority of cases are seen in postmenopausal women, but the condition can also occur in younger women and men.

The incidence of FFA is also not well-defined, but it is believed to be increasing. This increase may be due to improved recognition and diagnosis of the condition, as well as an increase in the number of individuals who are at risk due to genetic, hormonal, and environmental factors. The condition is also more prevalent in certain ethnic populations, such as women of European descent. However, it is important to note that FFA can affect individuals of any ethnicity.

Causes and Risk Factors

Genetic predisposition

Frontal fibrosing alopecia (FFA) is believed to have a genetic component. Studies have shown that individuals with FFA have a higher rate of family history of autoimmune disorders such as lupus and rheumatoid arthritis. Furthermore, research has identified several genetic markers that are associated with an increased risk of developing FFA. These markers are mainly located on chromosomes 1, 6, and 16, which are associated with the immune system and inflammation.

The exact genetic mechanisms that lead to FFA are not yet fully understood. However, researchers believe that a combination of genetic and environmental factors may trigger the condition. The genetic predisposition combined with certain environmental triggers, such as hormonal changes or exposure to toxins, may lead to the development of FFA.

Hormonal factors

Hormonal factors are believed to play a role in the development of frontal fibrosing alopecia (FFA). Studies have shown that FFA is more common in postmenopausal women, suggesting that hormonal changes may be a contributing factor. Estrogen, in particular, has been found to play a role in hair growth and maintenance. The decrease in estrogen levels that occurs during menopause may contribute to the development of FFA.

Research has also found that the use of hormonal therapy, such as hormone replacement therapy (HRT) and oral contraceptives, may also increase the risk of FFA. These therapies can alter the levels of hormones in the body, which may trigger the development of FFA. It is important to note that while hormonal factors may contribute to the development of FFA, they are not the sole cause of the condition. Other factors, such as genetic predisposition and environmental exposures, also play a role.

Environmental factors

Environmental factors are also believed to play a role in the development of frontal fibrosing alopecia (FFA). Exposure to toxins and pollutants, such as UV radiation, smoke, and pesticides, may contribute to the development of the condition. These toxins and pollutants can cause inflammation and damage to the hair follicles, leading to scarring and hair loss.

Symptoms and Diagnosis

Physical symptoms of FFA

The primary symptom of frontal fibrosing alopecia (FFA) is hair loss. Individuals with FFA typically develop a distinctive band of hair loss along the forehead and temples, which may be accompanied by a receding hairline. The hair loss is gradual and progressive, and may eventually lead to complete baldness of the affected areas. In some cases, FFA may also cause itching, burning, or pain on the scalp.

Another symptom of FFA is the development of scarring on the scalp. This scarring can be seen as small, white bumps or thickened, shiny skin on the scalp. As the condition progresses, the hair follicles may become completely destroyed, leading to permanent hair loss and scarring. In some cases, FFA may also cause changes in the texture of the remaining hair, such as coarseness or curling.

Diagnostic criteria

Diagnosis of frontal fibrosing alopecia (FFA) is based on clinical examination and a patient’s medical history. The diagnosis is usually made by a dermatologist, who will examine the scalp and hair for the characteristic symptoms of FFA, such as hair loss, scarring, and changes in hair texture. The dermatologist will also take a detailed medical history, including any family history of autoimmune disorders, hormonal changes, and environmental exposures.

There are several diagnostic criteria that are used to diagnose FFA. The most commonly used diagnostic criteria are the Ludwig scale, which requires the presence of hair loss, scarring, and a band of hair loss along the forehead and temples. Other criteria, such as the Hamilton-Norwood scale and the Savin scale, are also used to diagnose FFA. In some cases, a scalp biopsy may be performed to confirm the diagnosis.

Differential diagnosis

Frontal fibrosing alopecia (FFA) can be mistaken for other types of hair loss, such as androgenetic alopecia (AGA) and telogen effluvium. This is why it is important to rule out other conditions before making a diagnosis of FFA.

Importance of a proper diagnosis

A proper diagnosis of frontal fibrosing alopecia is crucial in managing the condition and preventing further hair loss. If left untreated, FFA can progress and lead to significant hair loss and scarring, which can be difficult to reverse. Early diagnosis also allows for the implementation of appropriate treatment and management plans, which can slow or halt the progression of the condition.

Treatment and Management

Medical treatment options

Medical treatment options for frontal fibrosing alopecia (FFA) include topical and oral medications. Topical medications, such as corticosteroids and minoxidil, can help to reduce inflammation and promote hair growth. Oral medications, such as doxycycline and isotretinoin, can also be used to reduce inflammation and promote hair growth.

Immunosuppressive medications, such as methotrexate and cyclosporine, are also used in the treatment of FFA. These medications suppress the immune system and can help to slow or halt the progression of the condition. It is important to note that immunosuppressive medications can have serious side effects, and they should only be used under the close supervision of a healthcare professional.

Lifestyle changes and self-care

Lifestyle changes and self-care measures can also play an important role in managing frontal fibrosing alopecia (FFA). These measures can help to reduce inflammation, promote hair growth, and alleviate the emotional impact of hair loss.

One of the most important self-care measures is to protect the scalp from sun damage. This can be done by wearing a wide-brimmed hat or applying sunscreen to the scalp. Avoiding harsh hair treatments and hairstyles that pull on the hair, such as tight ponytails and braids, can also help to prevent further hair loss and scarring.

Additionally, maintaining a healthy diet, getting regular exercise, and managing stress can also play a role in managing FFA. These measures can help to reduce inflammation, promote hair growth, and improve overall health. It’s also important to consult with a dermatologist or a trichologist to provide you with a personalized self-care plan that suits your condition.

Surgery and hair restoration options

Surgery and hair restoration options can be considered for individuals with frontal fibrosing alopecia who have experienced significant hair loss and scarring. Hair transplantation is a surgical procedure that involves the transplantation of hair follicles from one area of the scalp to the affected area. This procedure can help to restore hair growth and improve the appearance of the scalp.

It’s important to note that these surgical options can be expensive, and they may not be covered by insurance. A hair transplant in Turkey at Cosmedica Clinic Istanbul is an affordable alternative since the hair transplant cost in Turkey is much lower than in other Western nations.