Information on Frontal Fibrosing Alopecia. FFA.

Images of Frontal Fibrosing Alopecia.

What is frontal fibrosing alopecia? Useful Information.

• Frontal fibrosing alopecia is frontotemporal recession of the hairline and eyebrow hair loss, usually in postmenopausal women 

• It is associated with perifollicular erythema (redness around the follicle of the scalp), especially along the hairline.

• Frontal fibrosing alopecia is considered a variant of lichen planopilaris, a chronic inflammatory condition affecting skin and mucosal surfaces, but in this case affects the hair. It's a form of scarring alopecia where the hair follicles are destroyed and replaced with scar tissue. This leads to patchy hair loss, redness, scaling, and sometimes itchy or burning on the scalp. It is more common in women and usually develops in adulthood.

What are the first signs of frontal fibrosing alopecia? Useful Information.

• A uniform linear band of hair loss along the front and sides of the scalp 

• You may notice forehead or other skin areas that have no sun damage. 

• Skin may be shiny, pale or mildly scarred without visible hair follicle openings

• The hair pull test is negative (the test where doctor pulls five or six hairs to test for active hair loss).

• Isolated hairs may persist in the bald area – known as the lonely hair sign.

• There is often accompanying eyebrow thinning or madarosis.

• Lesser numbers of patients will have complete hair loss from under arms, pubic hair and limbs.

• For men, sideburns and beard may be involved, sometimes the only area involved.

• Itch and pain may occur in early stages.

• Facial rashes are another early sign (forehead and temples).

• Diffuse redness or red dots around the hairs

• Typical patterns include a diffuse zigzag pattern.

• In men, FFA is commonly misdiagnosed as male pattern baldness.

What is the cause of frontal fibrosing alopecia? Useful Information.

Causes of these conditions include:

• Genetics

• Hormonal changes of post-menopausal patients

• The condition is frequently reported in patients with other comorbid conditions such as hypothyroidism, Type 2 diabetes and autoimmune diseases such as lupus and rheumatoid arthritis.

• Contact allergy to perfume, moisturisers, sunscreen, hair dye remain unconfirmed but possible factors. 

How common is frontal fibrosing alopecia and who gets it? Useful Information.

• The incidence of androgenic alopecia (male pattern baldness) impacts more than 50% of men over 50 years, and many women as well after menopause. 

• FFA was first reported in 1994, and subsequently, reports of this diagnosis have continued to increase. 

• In a multicenter, retrospective study that included patients evaluated in specialist hair clinics in Europe, America, Africa, and Australia, FFA accounted for 11 percent of 3133 diagnosis of alopecia and 40 percent of 840 diagnoses of cicatricial alopecia.

• FFA appears to be an adult-onset disorder; the disorder has not been reported in children. FFA is most frequently diagnosed in postmenopausal women between 55 and 70 years of age but may also occur in other adults.

• In one of the largest series, a Spanish, multicenter, retrospective study, 83 percent of 355 patients with FFA were postmenopausal women.

• Premenopausal women and men accounted for 14 and 3 percent of the patients, respectively. However, a review of 20 patients with confirmed FFA in a single center in South Africa found a contrasting distribution; the patients included 5 postmenopausal women, 14 premenopausal women, and 1 man.

How is frontal fibrosing alopecia diagnosed? Useful Information.

• Usually, frontal fibrosing alopecia is slowly progressive although it is self-limiting in most cases after several years, with the hair line receding on average of 1.8-2.6 cm.

• As it is a scarring alopecia, hair does not grow back; so it’s important to prevent further hair loss with early treatment and diagnosis. 

Is alopecia (areata) the same as frontal fibrosing alopecia? Useful Information.

• Whilst both conditions cause hair loss, alopecia areata is more common in younger individuals and presents as round patches of normal looking skin and hair may grow back because it is not a scarring alopecia. 

• FFA is much more common in women over 50 and presents as band-like hair loss. 

• It is a scarring alopecia and unfortunately the hair will never grow back.

• Wig Wise can offer a variety of wigs, and possible hair solutions to help with disguising FFA, allowing you to go about your normal life with confidence and support.