Frontal Fibrosing Alopecia (FFA)

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Frontal fibrosing alopecia (FFA) is a progressive cicatricial alopecia primarily affecting the frontal and temporal hairlines, often accompanied by eyebrow loss. First described by Steven Kossard in 1994, FFA has since emerged as a globally recognised condition, predominantly affecting postmenopausal women, though cases in men, premenopausal women, and adolescents are reported. Its pathogenesis remains unclear, involving autoimmune, hormonal, genetic, and environmental factors. Histopathological similarities to lichen planopilaris (LPP) suggest a potential overlap. FFA progresses slowly and is challenging to diagnose early, with symptoms such as hairline recession, perifollicular erythema, and scalp fibrosis. The condition is often associated with thyroid disorders, rosacea, and other autoimmune diseases. FFA’s multifactorial aetiology includes immune dysfunction, PPAR- γ dysregulation, and hormonal influences, with oestrogen depletion being significant in postmenopausal women. Environmental factors, such as certain skincare products and surgeries, may trigger the disease in genetically predisposed individuals. Treatments aim to halt disease progression and alleviate symptoms, as hair regrowth is typically unattainable once scarring occurs. Topical corticosteroids, calcineurin inhibitors, 5α-reductase inhibitors, and systemic agents like hydroxychloroquine are commonly used, but no standardised treatment exists. Ongoing research seeks to clarify its pathogenesis and improve therapeutic options. Early diagnosis and tailored management are essential to mitigate FFA’s impact.