Frontal fibrosing alopecia

Title

Other Names:

FFA

Categories:

Skin Diseases

Summary Summary

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

Symptoms Symptoms

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

Cause Cause

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

Inheritance Inheritance

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

Diagnosis Diagnosis

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

Treatment Treatment

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

Prognosis Prognosis

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

Research Research

Research helps us better understand diseases and can lead to advances in diagnosis and treatment. This section provides resources to help you learn about medical research and ways to get involved.

Clinical Research Resources

ClinicalTrials.gov lists trials that are studying or have studied Frontal fibrosing alopecia. Click on the link to go to ClinicalTrials.gov to read descriptions of these studies.

Organizations Organizations

Nonprofit support and advocacy groups bring together patients, families, medical professionals, and researchers. These groups often raise awareness, provide support, and develop patient-centered information. Many are the driving force behind research for better treatments and possible cures. They can direct people to research, resources, and services. Many groups also have experts who serve as medical advisors. Visit their website or contact them to learn about the services they offer. Inclusion on this list is not an endorsement by GARD. Suggest an organization to add.

Organizations Supporting this Disease

American Hair Loss Association
23679 Calabasas Road # 682
Calabasas, CA 91301-1502
E-mail: inquire@americanhairloss.org
Website: http://americanhairloss.org
Cicatricial Alopecia Research Foundation (C.A.R.F.)
303 West State Street
Geneva, IL 60134
Telephone: 310-801-3450
E-mail: info@carfintl.org
Website: http://www.carfintl.org

Social Networking Websites

Alopecia World is a social networking site that offers support, resources, and information for people living with hair loss.

Learn More Learn More

These resources provide more information about this condition or associated symptoms. The in-depth resources contain medical and scientific language that may be hard to understand. You may want to review these resources with a medical professional.

Where to Start

The Cicatricial Alopecia Research Foundation has an information page on Frontal fibrosing alopecia. Click on the link to view this information page.
DermNet NZ is an online resource about skin diseases developed by the New Zealand Dermatological Society Incorporated. DermNet NZ provides information about this condition.

In-Depth Information

Medscape Reference provides information on this topic. You may need to register to view the medical textbook, but registration is free.
The Monarch Initiative brings together data about this condition from humans and other species to help physicians and biomedical researchers. Monarch’s tools are designed to make it easier to compare the signs and symptoms (phenotypes) of different diseases and discover common features. This initiative is a collaboration between several academic institutions across the world and is funded by the National Institutes of Health. Visit the website to explore the biology of this condition.
Orphanet is a European reference portal for information on rare diseases and orphan drugs. Access to this database is free of charge.
PubMed is a searchable database of medical literature and lists journal articles that discuss Frontal fibrosing alopecia. Click on the link to view a sample search on this topic.

Related Diseases Related Diseases

The following diseases are related to Frontal fibrosing alopecia. If you have a question about any of these diseases, you can contact GARD.

Lichen planopilaris

GARD Answers GARD Answers

Questions sent to GARD may be posted here if the information could be helpful to others. We remove all identifying information when posting a question to protect your privacy. If you do not want your question posted, please let us know. Submit a new question

I have been diagnosed with frontal fibrosing hair loss (alopecia). Is this condition going to cause all of my hair to fall out or will the hair loss stop at some point? Will medication help, or are the side effects too concerning? See answer

References References

Arnold S. & Cooper S. Frontal fibrosing alopecia. Orphanet. May 2011; http://www.orpha.net/consor/cgi-bin/OC_Exp.php?lng=en&Expert=254492.
Frontal fibrosing alopecia. DermNet NZ. January 2015; http://dermnetnz.org/hair-nails-sweat/frontal-fibrosing-alopecia.html.
Basil M Hantash, MD. Scarring Alopecia. Medscape Reference. March 2014; http://emedicine.medscape.com/article/1073559-overview.
Shapiro J & Otberg N. Lichen planopilaris. UpToDate. November 2014;
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.
Junqueira Ribeiro Pereira AF, Vincenzi C, Tosti A. Frontal fibrosing alopecia in two sisters. Br J Dermatol. May 2010; 162(5):1154-1155.
Frequently Asked Questions. Cicatricial Alopecia Research Foundation. September 2011; http://www.carfintl.org/faq.php. Accessed 8/9/2013.
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.