Frontal Fibrosing Alopecia (FFA) Part I - Diagnosis and Clinical Presentation

Abstract

Frontal Fibrosing Alopecia (FFA) is a primary lymphocytic cicatricial alopecia predominantly affecting postmenopausal Caucasian women. It is characterized by a progressive frontotemporal hairline recession that presents as a scarring hairless band and is often accompanied by eyebrow and body hair loss. Although initially described in postmenopausal women, FFA has been observed in a broader demographic, including premenopausal women and occasionally men. The etiology remains elusive, with potential factors including genetic predisposition, hormonal influences, and chemical exposures playing a role. FFA exhibits a slow and distinctive progression, which sets it apart from other hair loss conditions. Apart from environmental factors, improved recognition and increased awareness have contributed to the growing number of diagnosed cases worldwide, a trend characterized by some as epidemic. In this CME article, part I, we provide a comprehensive review of FFA, encompassing its historical background, demographic features, clinical subtypes, trichoscopy findings, and diagnostic criteria.

Keywords: Advanced imaging; Alopecia; Artificial intelligence; Clinical patterns; Clinical trials; Cosmetic ingredients; Demographics; Dermatological disorder; Disease activity; Environmental triggers; Facial papules; Frontal Fibrosing Alopecia; Genetic predisposition; Global impact; Hair loss; Histology; Hormonal influences; Infrared thermography; Lichen Planus Pigmentosus (LPPigm); Limb involvement; Optical Coherence Tomography (OCT); Postmenopausal women; Rosacea; Severity assessment; Trichoscopy.