Frontal Fibrosing Alopecia

In the early stages of FFA redness (erythema) and dry skin (scaling) is seen around the hair follicles along the frontal hair line. The temples , eyebrows and arms can also be affected. Inflammation occurs in the hair follicle.

Frontal Fibrosing Alopecia (FFA) was first described in the 1980s and was initially rare. It is now diagnosed more frequently and there are various theories as to why it may be becoming more common.  This form of hair loss is almost exclusively seen in women with only very rare cases in men. The main theory currently is that frequent use of sun screens is triggering the activation of the immune system in the skin. Most sunscreens contain chemicals that dissipate the energy within the UV light and prevent sun damage. This is currently an unproven theory.

In the early stages redness (erythema) and dry skin (scaling) is seen around the hair follicles along the frontal hair line. The temples , eyebrows and arms can also be affected. Inflammation occurs in the hair follicle. If the inflammation is severe enough the hair follicle stem cells are destroyed which means that a new hair cannot grow from the follicle. The follicle disappears and the skin takes on a scarred appearance . FFA is classified as a scarring alopecia.

The following images show a case of FFA.

FFA

IMG_4977

 

Treatment.

There are no proven treatments for FFA. Any local treatments need to be targeted at the affected hair follicles and the hair behind the affected area to try and preserve these hair follicles. The main principles of treatment are to reduce the inflammation and prevent stem cell death.

Options include

  1. Topical steroid creams
  2. Injected steroids.
  3. Tablets to suppress the immune system such as hydroxychloroquine.

It can be very difficult to assess whether treatments are working. The clinical course for many cases of FFA is not for complete hair loss. The inflammation occurs for a period of time, damage is don and then everything stops. Patients will often present quite late having noticed their hair loss. If they then start a treatment they may think it is working when actually their diseases process was simply coming to a natural end. There is no way of telling how long FFA inflammation will last so many patients opt for treatment so that they are doing all they can to limit further hair loss.

It is important to take structured photos to monitor the progression of the disease and the response to treatment. Patients can do this themselves using skin monitoring apps such as MySkinSelfie.

 

Frontal Fibrosing Alopecia Treatments

Topical steroids Hydroxychloroquine Injected steroids

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