Frontal Fibrosing Alopecia (Scarring Alopecia)

What is Frontal Fibrosing Alopecia (FFA)?

Frontal Fibrosing Alopecia is a type of scarring hair loss that affects the frontal region of the scalp (i.e. the forehead and sideburns). It is believed to be localised form of Lichen Planopilaris. It most often affects post-menopausal women, but it can also affect men and younger women. Frontal Fibrosing Alopecia is becoming more and more common.

What does Frontal Fibrosing Alopecia look like?

In Frontal Fibrosing Alopecia, hair loss and scarring make the hairline recede, across the forehead and sideburns of the scalp. The skin of the scalp that is affected often looks normal, but it can look pale or shiny and no hair follicles can be seen. In some cases, redness and scaling can be seen around hair follicles at the edges of the affected scalp. About 50% of people lose hair from their eyebrows and a few may lose hair from their eyelashes and/or other parts of the body. Some people also have skin-coloured bumps on their face, called papules, where the fine hairs on the skin are under attack. Frontal Fibrosing Alopecia often occurs without symptoms, but people can experience an itchy, painful or burning sensation in a band across the frontal hairline.

How is Frontal Fibrosing Alopecia diagnosed?

Frontal Fibrosing Alopecia is usually diagnosed using a combination of trichoscopy (examining the hair and scalp using a microscope) often accompanied by a scalp biopsy from the edge of the affected area to confirm the diagnosis.

Is Frontal Fibrosing Alopecia permanent?

Yes, in this condition, the hair follicles are destroyed and turned into scar tissue. Frontal Fibrosing Alopecia is a slowly progressive condition, which means that the areas of the scalp that are affected by the condition will gradually increase over time. In some people, the condition stops progressing and there have been some rare reports of regrowth.

What causes Frontal Fibrosing Alopecia?

Genetic studies of Frontal Fibrosing Alopecia suggest that this is an autoimmune condition, in which an affected person's immune system mistakenly attacks the hair follicles and destroys them. Although triggers are not yet clear, hormones and other environmental factors are thought be involved. There are several descriptions of multiple family members all being affected by Frontal Fibrosing Alopecia, so there is likely to be a hereditary element to this condition, although not everyone with Frontal Fibrosing Alopecia has a relative with the condition.

Can Frontal Fibrosing Alopecia be treated?

The hair loss caused by Frontal Fibrosing Alopecia cannot be reversed and there are no truly effective treatments to date. Treatments used to slow the progression of the condition include oral corticosteroids, intralesional steroid injections, anti-inflammatory antibiotics such as tetracyclines, or anti-malarial tablets (hydroxychloroquine). All these treatments aim to lower the activity of the immune system and slow down the attack on the hair follicles.

Additional Information:

The British Association of Dermatologists have produced a patient information leaflet about Frontal Fibrosing Alopecia:

CLICK HERE TO SEE THE BAD PATIENT INFORMATION LEAFLET ON FFA

Oxford University Hospitals also have a useful patient information leaflet:

CLICK HERE TO SEE THE OUH PATIENT INFORMATION LEAFLET ON FFA

The Scarring Alopecia Foundation, SAF, have some detailed information:

CLICK HERE TO VISIT THE SAF WEBSITE

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