Frontal fibrosing alopecia: a disease that remains enigmatic

Abstract

Frontal fibrosing alopecia (FFA) is recognized to represent a generalized process of inflammatory scarring alopecia. Apart from the classic form affecting the frontal hairline, there are a range of disease manifestations involving loss of eyebrows and of eyelashes, loss of peripheral body hair, fibrosing alopecia in a pattern distribution, facial and extrafacial skin, mucous membrane, and nail involvement. Classic linear, diffuse "zigzag", pseudo "fringe sign", androgenetic alopecia-like, cockade-like, ophiasis-like and incomplete patterns are distinguished. The aetiology of FFA remains obscure, but a number of pathogenetic hypotheses and treatments to halt disease progression have been proposed.

Keywords: diagnostics; etiopathogenesis; scarring alopecia; therapy.

Figure 1

Frontal fibrosing alopecia: a classic linear pattern of hair loss

Figure 2

Atypical patterns of hair loss in frontal fibrosing alopecia: A – diffuse “zigzag”, B – pseudo “fringe sign”, C – ophiasis-like, D – androgenetic alopecia-like, E – cockade-like

Figure 3

Trichoscopy findings in frontal fibrosing alopecia: loss of follicular openings, peripilar casts and perifollicular erythema, absence of vellus and presence of lonely hairs