Frontal fibrosing alopecia: state of the art and future directions

Joana R. Lascasas, Joana S. Peixoto, Sofia C. Vedor


Frontal fibrosing alopecia (FFA) is a primary lymphocytic cicatricial alopecia, characterized by recession of frontotemporal hairline with frequent involvement of eyebrows and affecting occasionally other body areas. Entitled an emerging epidemic, due to its rising incidence, FFA etiology remains unclear without proven effective therapies. This study reviews relevant publications on FFA, regarding pathogenesis, clinical findings, histology along with treatment and prognosis. A bibliographic search was conducted in the main international databases, using the term ‘FFA’. Guidelines, observational studies, randomized controlled trials, reviews, systematic reviews and meta-analysis regardless of publication date, presented in English, Portuguese or Spanish, were included in this review. 50 publications were fully analysed. The majority of FFA cases were observed in postmenopausal women, although both men and women from younger ages can be victims. From an etiological point of view, immune-mediated hypothesis is widely spread, as stem cells localized in the bulge region of the follicle are destroyed by an inflammatory infiltrate. However, environmental factors raised interest, since sunscreen use was related to a bigger incidence of FFA. Three clinical patterns have been described. Yet the failure to use standardized assessment methods in addition to the absence of prospective studies evaluating available therapies, do not concede comparable data. Spontaneous stabilization of disease can occur, but regrowth was only seen in scarce cases. Outcomes from randomized controlled trials and prospective studies are missing to draw further understanding of FFA.


Alopecia, Lichen planopilaris, Follicular lichen planus, Scarring alopecia, Lymphocytic cicatricial alopecia

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