Frontal fibrosing alopecia

1 - SUMMARY

Frontal fibrosing alopecia (FFA) was described in Australia in 1994. It is characterised by a band of scarring alopecia affecting the anterior scalp. Loss of eyebrows is often associated as is involvement of the underarm and pubic hair, facial vellus hair and body hair. FFA is a form of lichen planopilaris (LPP) with a specific topographical pattern. Histology shows a lymphocytic infiltrate around the isthmus and infundibular areas together with a reduced number of follicles with fibrous tracts in their place. FFA affects women after the menopause although cases in men and young women have been described. The incidence of FFA is on the increase. Its pathophysiology is unknown. The course is one of spontaneous stabilisation over a number of years. No treatment has been formally proven to be of long-lasting efficacy but topical or intradermal steroids, tetracycline antibiotics and oral 5-alpha-reductase inhibitors seem to slow the process down.