Frontal Fibrosing Alopecia in Women: The Mayo Clinic Experience With 148 Patients, 1992-2016

<p>Optimal Management of Frontal Fibrosing Alopecia: A Practical Guide</p>

“…1,2,4 Pruritus, facial papules, eyelash loss, body hair involvement, and trichodynia may also occur in addition to the frontotemporal recession and eyebrow loss classically seen. 4,5,10,11 Depression of frontal veins, 12 hypopigmentation of the frontal hairline, 13 and lonely hairs 14,15 are other often reported clinical features. Early diagnosis and prompt treatment are critical as FFA is a progressive disorder that can result in permanent hair loss.…”

“…10 Table 1, formatted from "Reply to: 'Updated diagnostic criteria for frontal fibrosing alopecia'" in the Journal of the American Academy of Dermatology, outlines the current established diagnostic criteria of FFA. 15 While FFA is usually seen in postmenopausal women, 1,2 it has also been recognized in premenopausal women [3][4][5]10 and men. 4,16 The etiology and pathogenesis of FFA are not completely understood and remain areas of active investigation.…”

“…7 Case reports and cohort studies have reported improvement and remission through the use of various therapies including 5-alpha-reductase inhibitors, 4,10 topical and intralesional corticosteroids, 4,5,10 topical and oral immunomodulators, 5,10 hydroxychloroquine, 4,5,10 isotretinoin, 20 antibiotics, 10,21,22 and pioglitazone. 10,22 Although treatment outcomes are variable and there remains a lack of data on treatment efficacy, combination therapy, particularly including systemic treatments, does appear helpful in slowing disease progression and maintaining disease stabilization. 10 Table 2 provides a current summary of FFA treatment options reported in the literature, while Figure 1 provides a suggested treatment algorithm.…”

Renaming frontal fibrosing alopecia is a step too far

“…Indeed, large case series show that several clinical findings other than scarring hair loss in the frontotemporal region are frequent in FFA, including eyebrow loss in the majority of patients and body hair loss and facial papules in some cases. 2,3 To adopt lichen planopilaris of Kossard as the accepted term would entrench the pervasive concept of FFA as being a specific variant of lichen planopilaris (LPP). However, Tziotzios et al themselves highlight several features of FFA that are in direct contrast with classic LPP, including a predilection for postmenopausal women, the absence of cases in children, and a markedly different pattern of hair loss on the scalp.…”

“…4 Cases of FFA in association with cutaneous or mucosal lichen planus are also infrequent. 2 Kossard suggested a link between FFA and LPP based on common histologic findings of perifollicular lichenoid inflammation and fibrosis. 5 Whether these represent the result of a single pathomechanism or simply the shared end points of distinct disease processes has yet to be established.…”