From the Guidelines
Frontal fibrosing alopecia (FFA) is a progressive scarring alopecia that requires prompt management to prevent irreversible hair loss, with first-line treatments including topical anti-inflammatories and oral 5-alpha-reductase inhibitors. The clinical presentation of FFA includes a band-like recession of the frontal and temporal hairline with perifollicular erythema and scaling, and key symptoms include mild itching, burning, or pain in the affected areas 1. Diagnostic signs include lonely hairs (isolated terminal hairs within the alopecia), facial papules, and loss of eyebrows in 80% of cases. Some key points to consider in the management of FFA include:
- The importance of counseling patients on the nature and course of the disease, as well as the available treatments, to help them cope with the psychological and social effects of hair loss 2
- The need to consider both the positive and negative aspects of active treatment, including the potential for spontaneous remission and the risk of adverse effects 3
- The use of high-potency corticosteroids, such as clobetasol 0.05% solution, and oral 5-alpha-reductase inhibitors, such as finasteride (2.5-5mg daily) or dutasteride (0.5mg daily), as first-line treatments 4
- The potential benefits of adding hydroxychloroquine (200-400mg daily) for its anti-inflammatory properties, and the use of intralesional corticosteroid injections (triamcinolone 10mg/ml) to target active areas 5 It is also important to note that the prognosis for FFA is variable, with some patients experiencing spontaneous remission and others progressing to more severe forms of the disease, such as alopecia totalis or alopecia universalis 5. Overall, the management of FFA requires a comprehensive approach that takes into account the physical and emotional effects of the disease, and involves a combination of medical and supportive therapies to help patients achieve the best possible outcomes.
From the Research
Clinical Presentations
- Frontal fibrosing alopecia (FFA) is characterized by progressive frontotemporal hairline recession, often associated with eyebrow loss and other symptoms such as pruritus, facial papules, eyelash loss, body hair involvement, and trichodynia 6.
- The disease most often affects postmenopausal women, with a distinctive clinical pattern of hair loss 7, 8.
- Scalp pruritus and perifollicular erythema are common presenting symptoms and signs, respectively 9.
Symptoms and Signs
- Hairline recession is the primary symptom, with 75% of patients also reporting eyebrow loss 9.
- Scalp pruritus (67%) and perifollicular erythema (86%) are common symptoms and signs, respectively 9.
- Other associated symptoms include facial papules, eyelash loss, body hair involvement, and trichodynia 6.
Management Options
- Treatment options for FFA include 5-α-reductase inhibitors, intralesional steroids, hydroxychloroquine, topical steroids, topical calcineurin inhibitors, systemic retinoids, pioglitazone, oral antibiotics, minoxidil, excimer laser, and hair transplantation 7.
- Intralesional steroids and 5α-reductase inhibitors have the most positive treatment responses, with 88% of patients showing improvement 10.
- Hydroxychloroquine has been shown to be effective in reducing signs and symptoms of FFA, with a statistically significant reduction in symptoms at 6- and 12-month follow-up 9.
- Early diagnosis and prompt treatment are critical, as FFA is a progressive disorder that can result in permanent hair loss 6.