What is Frontal Fibrosing Alopecia (FFA)? FFA, also known as cicatricial Alopecia, is a form of scarring alopecia (hair loss) characterized by hair recession on the forehead and sideburns. One might experience hair loss in other areas, such as the eyelashes, eyebrows, and pubic regions.
FFA is primarily linked to hormonal changes and is very common in women in the menopause stage; younger women in their post-teenage years and men of African descent, Asians, and whites have recorded the most cases.
We classify FFA into early and progressive stages.
- Early Stages
During the early stages of FFA, balding skin runs thinly on the front area of the scalp and sometimes on the sides. This condition starts slowly and progresses with time.
- Progressive FFA
As the condition advances, the affected areas appear pale, with no follicle openings, presenting an unusual appearance.
What Causes Frontal Fibrosing Alopecia (FFA)?
Experts have yet to discover the leading cause of FFA as it is scarce. FFA cases are increasingly getting reported, with some diagnosed alongside the female pattern of Androgenetic Alopecia.
Some of the suspected causes are:
Hormones
FFA typically affects women in their post-menopausal stage, which leads to the belief that hormones play a significant role in its development for older women. Hormonal tests for patients with FFA, however, rarely show abnormalities.
Genetics
Research is still underway to connect genetics to the cause of FFA; however, several patients have reported that family members suffer from the condition. Specialists suspect that specific genes increase the chances of developing the condition.
Autoimmune Disease
FFA can be related to another autoimmune disease, Lichen Planopilaris (LPP), which attacks healthy hair follicles. As an underlying condition, LPP can lead to FFA, as affected hair follicles become damaged, leading to scarring.
Surgeries
Iccorectly done hair transplants can damage the scalp or beard. It is advisable to consult a certified board doctor for such procedures.
Environmental Factors
Excessive sunscreen, medications, intense sun rays, and viral infections might cause FFA.
Symptoms of Frontal Fibrosing Alopecia (FFA)
Unlike other forms of Alopecia, FFA has few unnoticeable symptoms, which include:
- Hair loss on the front and scalp sides.
- Scarring from damaged hair follicles.
- Painful scalp.
- Yellow-colored bumps on the hairline
The least common symptom is hair loss on the:
- Eyebrows
- Eyelashes
- Beards
- Underarms
- Pubic areas.
How Do You Diagnose Frontal Fibrosing Alopecia (FFA)?
FFA is difficult to diagnose, considering its similarities with other scalp hair conditions. During the early stages, the symptoms are barely visible, which requires a consultation with an experienced specialist to avoid misdiagnosis.
Specialists physically examine the affected area, followed by a biopsy, in which the doctor observes samples extracted from the hair and scalp under a microscope.
A histological examination can confirm the diagnosis and trace FFA cases to a patient’s lineage.
Doctors conduct trichoscopy to increase the accuracy of diagnosing eyebrows, eyelashes, and pubic hairs because subtle symptoms may go unnoticed.
An association between FFA and other autoimmune diseases might require physicians to conduct additional tests, such as thyroid function and hematological and biochemical blood tests, to help establish the potential presence of different conditions.
What Does Frontal Fibrosing Alopecia Look Like?
What Treatments Are Available for Frontal Fibrosing Alopecia (FFA)?
There is no cure for FFA. However, there are several ways to manage and treat the symptoms and, in turn, slow down progression. With enough controlled trials, specialists can find a permanent solution to treat FFA. Therefore, patients must cautiously choose treatment methods to manage the condition effectively.
Some of the available methods include topical treatments and tablets.
Topical Treatments
- Inhibitor ointments. As a doctor prescribes, ointments can be applied directly on the scalp to reduce inflammation.
- Steroid Injections. Doctors use the injections when a tiny scalp area has been affected. Side effects may include skin thinning and discomfort. However, doctors have credited steroid injections with reducing FFA progression.
- Topical steroids, such as gels, lotions, and mousses, help relieve symptoms in the affected scalp areas.
Supplements
- Antibiotics. Patients can use supplements to reduce inflammation.
- Corticosteroids. Use steroid supplements in the short term to manage FFA symptoms. When used in the long run, one can experience side effects such as diabetes, high blood pressure, and weight gain.
- Hydroxychloroquine. These supplements help reduce pain and scalp itchiness. When prescribed in early FFA stages, it can help in hair regrowth.
- Finasteride. This (or the dutasteride) medications slow down the development of FFA.
Other treatment forms include:
- Laser therapy
- Hair transplants can be considered after several years of managing the disease.
- Medical tattooing to manage hair loss on the eyebrows.
Frontal Fibrosing Alopecia (FFA) Frequently Asked Question(FAQ)
Can Frontal Fibrosing Alopecia (FFA) be reversed?
If diagnosed early, you can manage FAA, and lost hair can be reversed.
How long does Frontal Fibrosing Alopecia (FFA) last?
In some patients, FFA can last for years and progress further if left untreated. If you suspect FFA, consult a certified board dermatologist like Dr. Sanusi Umar through this link: https://arabic.dru.com/hair-free-consultation/ or use the consultation button below.
Can Frontal Fibrosing Alopecia (FFA) be misdiagnosed?
FAA can be confused with female-pattern androgenetic alopecia (AGA) or, in some cases, with Traction Alopecia.
References
Eva Maria Valesky, et al. Frontal Fibrosing Alopecia – Review of Recent Case Reports and Case Series in PubMed. 1 Aug. 2018, https://doi.org/10.1111/ddg.13601. Accessed 3 Aug. 2023.
Fertig, Raymond, and Antonella Tosti. “Frontal Fibrosing Alopecia Treatment Options.” Intractable & Rare Diseases Research, vol. 5, no. 4, 2016, pp. 314–315, https://doi.org/10.5582/irdr.2016.01065. It was accessed 8 Aug. 2020.
Lacarrubba, F., Micali, G., & Tosti, A. (2013). Absence of vellus hair in the hairline is a videodermatoscopic feature of frontal fibrosing alopecia. British Journal of Dermatology, 169(2), 473–474. https://doi.org/10.1111/bjd.12316
Tosti, A., Piraccini, B. M., Iorizzo, M., & Misciali, C. (2005). Frontal fibrosing alopecia in postmenopausal women. Journal of the American Academy of Dermatology, 52(1), 55–60. https://doi.org/10.1016/j.jaad.2004.05.014