From a clinical point of view, this relatively uncommon condition is characterized by progressive frontotemporal recession due to inflammatory destruction. Frontal fibrosing alopecia treatment receding hairline. Frontal fibrosing alopecia, discovered only recently in hair loss terms in 1994, is also known as scarring alopecia or cicatricial alopecia and has a distinctive clinical pattern of hair loss characterised by progressive recession of the hairline at the front and sides of the scalp. We report the caseof a 46yearold man with a tenyear history of anerythematous patch with perifollicular erythemaat the superior aspect of the forehead.
Pdf stefanato c m 2010 histopathology56, 2438 histopathology of alopecia. A, active margin of the alopecia with perifollicular erythema and follicular scale. Frontal fibrosing alopecia ffa is an increasingly common acquired primary. It has distinctive features and associations which distinguish it from lpp. It is characterized by loss of frontotemporal hairline that mostly affects postmenopausal women, with a negative impact on quality of life. It is considered to be a variant of lichen plano pilaris as the pathology being same for this ailment. Treatment of the condition varies, although none can restore hair that has already been lost. A useful clue to the diagnosis is frequently the loss of eyebrows, a loss that can precede the frontal recession. Lichen planus pigmentosus and frontal fibrosing alopecia. Frontal fibrosing alopecia is the frontotemporal hairline recession and eyebrow loss in postmenopausal women that is associated with perifollicular erythema, especially along the hairline.
Frontal fibrosing alopecia genetic and rare diseases. The histopathology is that of a typical scarring alopecia with perifollicular concentric fibrosis, mild perifollicular and perivascular lymphoid cell infiltrate, destruction of the follicular epithelium, naked hair shafts in giant cells, and, in terminal phases, follicular dropout. Frontal fibrosing alopecia ffa is a lymphocytemediated primary cicatricial alopecia that affects frontal hairline and eyebrows. Although it has been suggested that ffa may be due to hormonal changes or an autoimmune response, the exact cause of. Frontal fibrosing alopecia is a kind of progressive and frequently irreversible cicatricial alopecia marked by a lichenoid infiltrate in histology. Its clinical presentation is characterized by alopecia along the frontal hairline that extends posteriorly with scarring. Traction alopecia hairs broken at different distances, miniaturized hairs, white dots and. It was first described in a group of australian women in 1994 1.
An idiopathic and slowly progressive form of cicatricial alopecia, presenting with multiple small alopecic patches on the vertex and parietal areas, in a pattern that has been defined as. The incidence of ffa has increased significantly during the last decade and we may be facing an epidemic of the disease. Clinically, the hair loss is often seen at the margins of the scalp, involving the frontal, temporal and parietal regions. Frontal fibrosing alopecia is a condition as name suggest scarring and hair loss seen precisely in the frontal region of the scalp in area above the forehead.
Hi all,as hydroxychloroquine plaquenil is a hot topic right now and is being discussed as a possible treatment for covid 19, i would be interested in whether anyone here who actually takes plaquenil has had symptoms of covid 19. A study of 40 patients was conducted to study the clinical variants and histopathology of cicatricial alopecia. In some cases, the eyebrows, eye lashes andor other parts of the body may be involved, as well. Frontal fibrosing alopecia is mostly found in fifth decade of life commonly. Frontal fibrosing alopecia is a specific form of scarring alopecia that affects the frontal hairline, most often in postmenopausal women. Despite the fact that individuals have been experiencing baldness and trying to find its causes sinc. In continuation from our previous article, we will continue to look at other aspects of frontal fibrosing alopecia. It is considered to be a variant of lichen plano pilaris as. Frontal fibrosing alopecia can often occur alongside a much more common condition called androgenetic alopecia, also known as genetic pattern baldness, or may superficially resemble traction alopecia, a condition where prolonged use of tight hairstyles damages the hair follicles. Frontal fibrosing alopecia absence of follicular openings, perifollicular scale, and a feeble. Frontal fibrosing alopecia ffa is a distinctive form of primary lymphocytic cicatricial. Eyebrow alopecia and facial hair involvement are commonly present.
A range of facial lesions have been described in ffa, such as lichen planus lp pigmentosus, red dots, facial papules, and perifollicular and. Is frontal fibrosing alopecia the reason for your hair. Abstract frontal fibrosing alopecia ffa is a form of hair loss with an unknown etiology seen in postmenopausal women. Women with frontal fibrosing alopecia ffa note a rapid onset of frontal hair recession. Nov 22, 20 dear soxfans, albertini, and sabina i hope that by now someone has led you to a confirmed diagnosis of frontal fibrosing alopecia ffa. Frontal fibrosing alopecia ffa is characterized primarily by hair loss alopecia and scarring on the scalp near the forehead. Frontal alopecia begins with loss of hair along the front of the hairline and this will slowly move backwards. Concomitant involvement of vellus at different body sites has recently been reported. Below is a stepbystep approach that can be used in scarring alopecia. Jun 19, 2015 an indepth introduction to frontal fibrosing alopecia. Frontal fibrosing alopecia describes hair loss and scarring in the frontal region of the scalp. The lonely hair sign is helpful to clinically distinguish frontal fibrosing alopecia from other conditions that can cause frontotemporal hair loss such as.
This condition is commonly considered to be a variant of lichen planopilaris and shares similar histopathologic findings to perifollicular lichenoid inflammation and fibrosis. This recession usually includes the temporal hairline. I ntroduction frontal fibrosing alopecia ffa was described by kossard et al. It is a type of alopecia known as scarring alopecia or cicatricial alopecia.
Frontal fibrosing alopecia an overview sciencedirect. Frontal fibrosing alopecia ffa is a form of scarring alopecia that presents as a progressive, symmetric bandlike zone of hair loss along the anterior hairline. At dermoscopy, the lonely hair is seen to be not affected by peripilar erythema or scales, but its surrounding skin shows loss of follicular openings typical of established scarring alopecia. Clinical inflammation is frequently, but not always, present. There may be some scarring along the front and sometimes the sides of your scalp. It is a variant of primary lymphocytic cicatricial alopecia, typically observed in postmenopausal women with a few cases reported in men. Jul 09, 2016 frontal fibrosing alopecia is a condition as name suggest scarring and hair loss seen precisely in the frontal region of the scalp in area above the forehead. It is a form of cicatricial alopecia and commonly accepted as a variant of lichen planopilaris, based on shared features in clinical appearance and histopathology. Frontal fibrosing alopecia ffa is a distinctive form of primary lymphocytic cicatricial alopecia that has been considered as a variant of lichen planopilaris because of the histopathologic similarity between both diseases. Background frontal fibrosing alopecia is considered a particular clinical form of lichen planopilaris that primarily involves the scalp hair over the frontal hairline. This is especially true if the biopsy specimen is inadequate, and the clinical history and pattern of the alopecia are not. It is commonly called scarring that results in hair loss in the frontal region of the scalp. There has been a recent rush of data regarding the combined presentation of lichen planus pigmentosus and frontal fibrosing alopecia in premenoposal women of dark skin.
Update on frontal fibrosing alopecia actas dermosifiliograficas. Interpretation of the histopathological findings of primary scarring and non. Frontal fibrosing alopecia ffa is a recently described inflammatory and scarring type of hair loss affecting almost exclusively women. Frontal fibrosing alopecia update baishideng publishing group. Frontal fibrosing alopecia, which was first reported 30 years ago, is a condition that is increasing in epidemic proportions, says jerry shapiro, m. Frontal fibrosing alopecia is one of the less wellknown causes of hair loss my doctor, in fact, had never heard of it. A range of facial lesions have been described in ffa, such as lichen planus lp pigmentosus, red dots, facial papules, and perifollicular and diffuse erythema. Frontal fibrosing alopecia is a scarring alopecia thatis characterized by recession of the frontotemporalhairline with the frequent loss of eyebrows.
It is one type of cicatricial scarring alopecia, which means the hair follicles are permanently damaged. Frontal fibrosing alopecia is the frontotemporal hairline recession and eyebrow loss in postmenopausal women that is associated with perifollicular erythema, especially along the hairline 648 it is considered to be a clinical variant of lichen planopilaris. One patient was asymptomatic, 10 reported pruritus, 5 burning and 4 felt pain. Cicatricial marginal alopecia low hair density and loss of follicular ostia, with thinned shafts of the. Frontal fibrosing alopecia ffa is a chronic lymphocytic cicatricial alopecia of unknown etiology. This is a type of primary cicatricial alopecia, in which the hair loss occurs in a pattern along the front part of the hairline. Frontal fibrosing alopecia ffa is a form of hair loss most often seen in postmenopausal caucasian women.
Frontal fibrosing alopecia ffa is more common in postmenopausal women, but it can occur in younger women. David weedon ao md frcpa fcaphon, in weedons skin pathology. Frontal fibrosing alopecia ffa is a primary lymphocytic cicatricial alopecia characterized by a progressive bandlike recession of the frontotemporal hairline and frequent loss of the eyebrows. Clinical and histopathological findings of frontal. Thyroid disease in alopecia areata, lichen planopilaris, and. Yet according to reports, more and more women and men. Traction alopecia, like trichotillomania, is a noninflammatory, nonscarring alopecia secondary to, which in this case is related, and is seen in of descent. Frontal fibrosing alopecia ffa is a scarring alopecia whose incidence is increasing significantly in our country. Frontal fibrosing alopecia ffa is a condition that causes hair loss at the front of the scalp and near the temples. Frontal fibrosing alopecia ffa is an acquired scarring alopecia currently considered a clinical variant of lichen planopilaris lpp. Frontal fibrosing alopecia most commonly affects postmenopausal women between the ages of 40 and 80 years, with an average age of 67, but multiple cases of ffa in premenopausal women in their 30s and 40s have also been reported, as have a handful of cases where the condition occurs in men. Jun 22, 2015 in continuation from our previous article, we will continue to look at other aspects of frontal fibrosing alopecia. Feb 26, 2018 a systematic approach to the evaluation of alopecia allows for more effective management.
Feb 26, 2018 scarring alopecias have loss of follicular ostia, or atrophy. Frontal fibrosing alopecia is a condition of unknown origin, histologically similar to classic lichen planopilaris and generally observed in. A frontal or frontotemporal band of scarring alopecia with eyebrow involvement is the classic presentation of the disease. What is frontal fibrosing alopecia part 1 ak clinics.
Frontal fibrosing alopecia ffa may be associated with other autoimmune conditions, and patients should be screened accordingly. Diagnosis is clinical and the disease most often affects postmenopausal women. As more women become aware of the hair loss due to frontal fibrosing alopecia and other hair loss conditions, they are conquering their hairline blues by finding treatments and beautiful hair loss solutions. Our purpose was to examine the clinicopathological features. Lymphocytic and granulomatous perifolliculitis with fibrosis can be seen in latestage ffa. Some authors consider ffa to be a distinct frontal variant of lichen planopilaris. Unfortunately, frontal fibrosing alopecia is a scarring cicatricial form of alopecia. Frontal fibrosing alopecia i s a form of alopecia hair loss that affects the area where the hairline meets the front of the scalp it can also affect areas around the ears, and can cause hair loss from the eyebrows as well believed to be a variant of lichen planopilaris, this condition causes hair loss when the affected hair follicles become inflamed. The question i get asked the most about living with frontal fibrosing alopecia ffa is about my bonded hairpiece. Dear soxfans, albertini, and sabina i hope that by now someone has led you to a confirmed diagnosis of frontal fibrosing alopecia ffa. The incidence of ffa has increased significantly during the last decade and we may be facing an epidemic. The depth of inflammation in frontal fibrosing alopecia and. Ffa is a condition which causes hair loss, mainly over the hairline at the front of your head. Clinical and histopathological findings of frontal fibrosing.
Frontal fibrosing alopecia is a form of slowly progressive alopecia,varying from one to ten years, and cicatricial that presents symmetrical retreat from the frontal and temporal borders of the hair implantation 7,8,12. Frontal fibrosing alopecia during treatment of chronic. Frontal fibrosing alopecia has become one of the most frequently seen causes of scarring alopecia at many specialist hair clinics. From the histopathological point of view, these 3 processes are almost indistinguishable, even in their active phases, and so they are described together. Clinicalhistopathological profile of the frontal fibrosing alopecia. The histopathological interpretation of scalp biopsy specimens of patients with. For the histopathology study, it is important to bear in mind that biopsy will be of.
Given that we have already looked at what the condition is, the history, the clinical features, the epidemiology as well as the pathogenesis, we will now continue to look at the differential diagnosis, how it presents itself and how it can be treated or contained. Histopathology of facial papules in frontal fibrosing alopecia and therapeutic response to oral isotretinoin. Tolkachjov, md, faad, facms if you are losing your eyebrows, sideburns, or front hairline, you may be dealing with more than just an agedependent hair loss. Schematic diagram of the st johns nonscarring alopecia protocol. Despite a dramatic recent increase in incidence the. Mar 18, 2020 understanding the type of hair loss you have is always important. Chew al1, bashir sj, wain em, fenton da, stefanato cm. Itpredominantly affects postmenopausal womenand only rarely affects men. Plaquenil hydroxychloroquine and covid 19 symptoms. Frontal fibrosing alopecia ffa, first described by kossard in the early 1990s, is a form of primary lymphocytic cicatricial alopecia characterized by selective.
An indepth introduction to frontal fibrosing alopecia. In many cases, the progression is so rapid and extensive that there is a loss of eyebrows too. Acquired dermal macular hyperpigmentation, frontal fibrosing alopecia, lichen planus pigmentosus. Dec 02, 2016 frontal fibrosing alopecia ffa is a form of lichen planopilaris that is characterized primarily by slowly progressive hair loss and scarring on the scalp near the forehead. Frontal fibrosing alopecia versus lichen planopilaris. It is divided into 3 types according to the clinical presentation. Pretreatment diagnosis for frontal fibrosing alopecia. We report a 27yearold black male presenting scarring alopecia with symmetrical retreat of the frontal and temporal borders of the hair implantation and eyebrow thinning. Journal of the american academy of dermatology, volume 78, issue 2, e45. Initial classification of alopecia type applying scarring alopecia terminology based on clinical features using histology findings to further supportdefine the diagnosis providing a. Frontal fibrosing alopecia ffa is a form of lichen planopilaris that is characterized primarily by slowly progressive hair loss and scarring on the scalp near the forehead. Frontal fibrosing alopecia is a rare condition in which hair loss follows a distinctive pattern characterized by progressive recession of the frontal hairline, with or without progressive loss of eyebrows. To our knowledge, this is the first report on the involvement of facial vellus by effects of the inflammatory process.
Frontal fibrosing alopecia an overview sciencedirect topics. Genomewide association study in frontal fibrosing alopecia. Frontal fibrosing alopecia is a patterned variant of lichen planopilaris and predominantly affects postmenopausal women. Causes and treatment of frontal fibrosing alopecia ffa. Notice atrophic, hypopigmented alopecic skin along the frontal hair line that is. Frontal fibrosing alopecia is a predominantly frontotemporal type of cicatricial alopecia that determines an irreversible loss of hair strands. The band of hair loss on the front and sides of the scalp is usually symmetrical and slowly progressive worsening over time.
Frontal fibrosing alopecia womens hair loss project forum. One type of hair loss many men and women experience is called frontal fibrosing alopecia. Expanding the spectrum of frontal fibrosing alopecia. This is especially true if the biopsy specimen is inadequate, and the clinical history and pattern of the alopecia are not known. Discussion here includes familial or genetic factors, etiology, and trials. As for the site of alopecia, all had frontal alopecia and the majority temporal 87. Frontal fibrosing alopecia ffa is a primary cicatricial alopecia characterized by loss of follicular stem cells, fibrosis, and a receding frontotemporal hairline, with frequent loss of eyebrows, and less commonly, body hair involvement. Frontal fibrosing alopecia ffa is a primary lymphocytic scarring alopecia occurring mainly in. Frontal fibrosing alopecia usually affects postmenopausal women over the age of 50.
Ultimately, histologic confirmation is the best method to confirm the presence of a fibrosingscarring process with loss of hair follicles. Frontal fibrosing alopecia ffa is a variant of lichen planopilaris lpp and is characterised as a progressive cicatricial alopecia affecting the frontotemporal hairline. Development of frontal fibrosing alopecia with a history of. It is thought to be related to another condition called lichen planus which, when. Indeed, thyroid disease has also been linked to clinically significant types of alopecia, including alopecia areata aa and telogen effluvium. On examination, perifollicular hyperkeratosis and erythema may be present. Lichen planopilaris frontal fibrosing alopecia variant. In traction alopecia, hairstyles that involve excessive pulling, damage the hair follicles and cause hair loss. Frontal fibrosing alopecia i s a form of alopecia hair loss that affects the area where the hairline meets the front of the scalp. In frontal fibrosing alopecia ffa, scalp alopecia dominates the clinical picture.
Sarcoidosis presenting as frontal fibrosing alopecia. With early treatment, traction alopecia can often be resolved, and great results have been seen from hair transplants. It can also affect areas around the ears, and can cause hair loss from the eyebrows as well. Its cause is unknown, however reports suggest that hormonal and immunological factors are involved in its etiol ogy. Journal compilation 2010 blackwell publishing ltd, histopathology, 56, 2438. Mild perivascular and perifollicular lymphocytic infiltrate concentrated around the hair bulge area, dermal fibrosis, loss of sebaceous glands and follicular dropout. Frontal fibrosing alopecia ffa is a primary lymphocytic scarring alopecia occurring mainly in postmenopausal women. It can be associated with loss of hairs from eye brows. How women are conquering their hairline blues is about receding hairline in women is much a reality for them as it is for men. Frontal fibrosing alopecia ffa is a recently described form of primary cicatricial alopecia, characterized by progressive recession of the frontotemporal hairline and eyebrow loss, occurring predominantly in postmenopausal women. Clinical diagnosis of lp pigmentosus was corroborated by histology in 9 patients. A bonded hairpiece simply means its kind of like a wig only its bonded or glued to my scalp so its technically semipermanent.