Objectives: Frontal fibrosing alopecia (FFA) is a lymphocytic primary scarring alopecia. It has an increasing incidence. FFA is currently the most frequent cicatricial alopecias. A total of 95% are women, mostly postmenopausal. The pathogenesis is unknown. A potential autoimmune and hormonal mechanisms seem to play a role. There is a genetic susceptibility to be determined. It is currently studied if some environmental factors are risk factors for FFA.
Results: The clinical presentation is typical: cicatricial alopecia located on the frontal and temporal areas + eyebrow alopecia +/- body hair loss +/- facial papules.
The diagnosis is usually made by the typical clinical presentation and the trichoscopic findings: absence of follicular openings, perifollicular erythema, follicular hyperkeratosis. In doubtful cases, the skin biopsy confirms the diagnosis.
Conclusion: The objective of medical treatment is to stop the progression of the disease and avoid worsening. The most useful therapies are: topical/intralesional steroids and oral antiandrogenic drugs (dutasteride and finasteride). Other drugs that can be used are antimalarial drugs and oral isotretinoin (this latter is very effective to improve facial papules). Hair transplant may be considered in very selected patients, although the results are worse than in androgenetic alopecia. In advanced cases, a aesthetic improvement by non-medical therapies should be considered (eyebrows micrpigmentation, wigs).
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