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Genetic and Rare Diseases Information Center (GARD)

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Frontal fibrosing alopecia


Other Names for this Disease

  • FFA
See Disclaimer regarding information on this site. Some links on this page may take you to organizations outside of the National Institutes of Health.

Overview

What is frontal fibrosing alopecia?

What are the signs and symptoms of frontal fibrosing alopecia?

What causes frontal fibrosing alopecia?

Is frontal fibrosing alopecia inherited?

How is frontal fibrosing alopecia diagnosed?

How might frontal fibrosing alopecia be treated?

What is the long-term outlook for people with frontal fibrosing alopecia?

What is frontal fibrosing alopecia?

Frontal fibrosing alopecia (FFA) is a form of lichen planus follicularis that is characterized primarily by slowly progressive hair loss (alopecia) and scarring on the scalp near the forehead. In some cases, the eyebrows, eye lashes and/or other parts of the body may be involved, as well. Although it has been suggested that FFA may be due to hormonal changes or an autoimmune response, the exact cause of this condition is not yet known.[1][2][3] There is currently no cure for FFA; however, treatment with certain types of medications may stop or slow hair loss in some cases.[2]
Last updated: 1/20/2015

What are the signs and symptoms of frontal fibrosing alopecia?

Frontal fibrosing alopecia (FFA) is characterized primarily by hair loss (alopecia) and scarring on the scalp near the forehead. The band of hair loss on the front and sides of the scalp is usually symmetrical and slowly progressive (worsening over time). The skin in the affected area often looks normal but may be pale, shiny or mildly scarred.[2]

Approximately half of all affected people experience loss of eyebrows, as well. Less commonly, the eyelashes may also be involved. Some people with FFA develop hair loss in areas other than the scalp and face.[1][4]

In some cases, women with FFA also have female pattern hair loss, which is associated with thinning of hair on the scalp due to increased hair shedding and/or a reduction in hair volume.[2]
Last updated: 1/20/2015

What causes frontal fibrosing alopecia?

The exact underlying cause of frontal fibrosing alopecia (FFA) is unknown. FFA is thought to be an autoimmune condition in which an affected person's immune system mistakenly attacks the hair follicles (structures in the skin that make hair). Scientists also suspect that there may be a hormonal component since the condition most commonly affects post-menopausal women over age 50.[1][2]
Last updated: 1/20/2015

Is frontal fibrosing alopecia inherited?

Frontal fibrosing alopecia is not thought to be inherited in most cases. It rarely affects more than one person in a family.[5][6]
Last updated: 1/20/2015

How is frontal fibrosing alopecia diagnosed?

Frontal fibrosing alopecia is often suspected based on the presence of characteristic signs and symptoms. The diagnosis can be confirmed by examining a small sample of skin (skin biopsy) from the affected area. In some cases, laboratory studies may be ordered to rule out other conditions that cause similar features.[2][3]
Last updated: 1/20/2015

How might frontal fibrosing alopecia be treated?

Unfortunately, there is currently no cure for frontal fibrosing alopecia (FFA).[2] Because the hair loss associated with this condition is thought to be caused by inflammation of hair follicles, treatment often involves using anti-inflammatory medications or ointments, such as corticosteroids or hydroxychloroquine (brand name Plaquenil), to reduce inflammation and suppress the body's immune system.[7] Medications that block the production of the male hormone 5-alpha reductase have been reported to stop further hair loss in some women.[2] Researchers continue to question whether treatment is effective or if hair loss in FFA just stops naturally.[8]
Last updated: 1/20/2015

What is the long-term outlook for people with frontal fibrosing alopecia?

The long-term outlook (prognosis) for people with frontal fibrosing alopecia varies. It is generally slowly progressive (worsening over time); however, the condition does stabilize after a few years in some cases.[2]
Last updated: 1/20/2015

References
  1. Arnold S. & Cooper S. Frontal fibrosing alopecia. Orphanet. May 2011; http://www.orpha.net/consor/cgi-bin/OC_Exp.php?lng=en&Expert=254492.
  2. Frontal fibrosing alopecia. DermNet NZ. January 2015; http://dermnetnz.org/hair-nails-sweat/frontal-fibrosing-alopecia.html.
  3. Basil M Hantash, MD. Scarring Alopecia. Medscape Reference. March 2014; http://emedicine.medscape.com/article/1073559-overview.
  4. Jerry Shapiro, MD; Nina Otberg, MD. Lichen planopilaris. UpToDate. November 2014; Accessed 1/20/2015.
  5. Chan DV, Kartono F, Ziegler R, Abdulwahab N, DiPaola N, Flynn J, Wong HK. Absence of HLA-DR1 positivity in 2 familial cases of frontal fibrosing alopecia. J Am Acad Dermatol. November 2014; 71(5):208-210.
  6. Junqueira Ribeiro Pereira AF, Vincenzi C, Tosti A. Frontal fibrosing alopecia in two sisters. Br J Dermatol. May 2010; 162(5):1154-1155.
  7. Frequently Asked Questions. Cicatricial Alopecia Research Foundation. September 2011; http://www.carfintl.org/faq.php. Accessed 8/9/2013.
  8. Tan KT, Messenger AG. Frontal fibrosing alopecia: clinical presentations and prognosis. British Journal of Dermatology. 2009; 160:75-79. http://www.ncbi.nlm.nih.gov/pubmed/18811690. Accessed 4/9/2012.


Other Names for this Disease
  • FFA
See Disclaimer regarding information on this site. Some links on this page may take you to organizations outside of the National Institutes of Health.