Frontal fibrosing alopecia
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| Frontal fibrosing alopecia | |
|---|---|
| Other names | FFA |
 | |
| Specialty | Dermatology |
Frontal fibrosing alopecia is the frontotemporal hairline recession and eyebrow loss in postmenopausal women that is associated with perifollicular erythema, especially along the hairline.: 648 It is considered to be a clinical variant of lichen planopilaris.
Presentation
There is loss of both terminal and vellus hairs that occurs in a bandlike pattern on the frontotemporal scalp. It is a scarring alopecia that has been associated with facial papules, glabellar red dots, a loss of eyebrows, and prominent venous vasculature in the forehead. Facial hyperpigmentation may occur in dark-skinned patients if association with lichen planus pigmentosus is present.
Associations
Frontal fibrosing alopecia has been most often reported in post-menopausal women with higher levels of affluence and a negative smoking history. Autoimmune disease is found in 30% of patients.
Pathogenesis
Although the pathogenesis of frontal fibrosing alopecia is poorly understood, autoimmune reaction and hormonal factors may play a role.
Diagnostic
Perifollicular erythema and scarring white patches are seen on dermoscopy. On scalp biopsy, lymphocytic and granulomatous perifolliculitis with eccentric atrophy of follicular epithelia and perifollicular fibrosis are visualized.
Differential diagnosis
Important diagnoses to consider include female pattern hair loss (FPHL), chronic telogen effluvium (CTE), and alopecia areata (AA). FPHL is a non-scarring progressive miniaturization of the hair follicle with one of three different characteristic patterns. CTE is an idiopathic disease causing increased hair shedding and bi-temporal recession, usually in middle aged women. AA is an autoimmune attack of hair follicles that usually causes hair to fall out in small round patches.
Treatment
Improvement or stabilization of the condition has been reported with topical and intralesional corticosteroids, antibiotics, hydroxychloroquine, topical and oral immunomodulators, tacrolimus, and most recently, 5α-reductase inhibitors. In one study, the use of antiandrogens (finasteride or dutasteride) was associated with improvement in 47% and stabilization in 53% of patients Recently, successful treatment of facial papules in patients with frontal fibrosing alopecia was described with oral isotretinoin.
See also
References
- ^ RESERVED, INSERM US14-- ALL RIGHTS. "Orphanet: Frontal fibrosing alopecia". www.orpha.net. Retrieved 26 April 2019.{{cite web}}: CS1 maint: numeric names: authors list (link)
- ^ Wang, Monga I, Sallee BN, Chen JC, Abdelaziz AR, Perez-Lorenzo R, Bordone LA, Christiano AM (Jul 2022). "Primary cicatricial alopecias are characterized by dysregulation of shared gene expression pathways". PNAS Nexus. 1 (3): pgac111. doi:10.1093/pnasnexus/pgac111. PMC 9308563. PMID 35899069.
- ^ Freedberg, et al. (2003). Fitzpatrick's Dermatology in General Medicine. (6th ed.). McGraw-Hill. ISBN 0-07-138076-0.
- ^ Lacarrubba, F; Micali, G; Tosti, A (Mar 18, 2013). "Absence Of Vellus Hair In The Hairline: A Videodermatoscopic Feature Of Frontal Fibrosing Alopecia". The British Journal of Dermatology. 169 (2): 473–4. doi:10.1111/bjd.12316. PMID 23496000. S2CID 9044042.
- ^ Kossard S, Lee MS, Wilkinson B. Postmenopausal alopecia: a frontal variant of lichen planopilaris. J Am Acad Dermatol. 1997;36(1):59.
- ^ a b c Macdonald A, Clark C, Holmes S. Frontal fibrosing alopecia: a review of 60 cases. J Am Acad Dermatol. 2012;67(5):955-61.
- ^ Banka N, Mubki T, Bunagan MJ, Mcelwee K, Shapiro J. Frontal fibrosing alopecia: a retrospective clinical review of 62 patients with treatment outcome and long-term follow-up. Int J Dermatol. 2014;53(11):1324-30.
- ^ Pirmez R, Donati A, Valente NS, Sodré CT, Tosti A. Glabellar red dots in frontal fibrosing alopecia: a further clinical sign of vellus follicle involvement. Br J Dermatol. 2014;170(3):745-6.
- ^ Vañó-galván S, Rodrigues-barata AR, Urech M, et al. Depression of the frontal veins: A new clinical sign of frontal fibrosing alopecia. J Am Acad Dermatol. 2015;72(6):1087-8.
- ^ Pirmez R, Duque-Estrada B, Donati A, Campos-do-Carmo G, Valente NS, Romiti R, Sodré CT, Tosti A. Clinical and dermoscopic features of lichen planus pigmentosus in 37 patients with frontal fibrosing alopecia. Br J Dermatol. 2016 May 28. doi: 10.1111/bjd.14722.
- ^ Kossard S. Postmenopausal frontal fibrosing alopecia: scarring alopecia in a pattern distribution. Arch Dermatol 1994;130:770-4.
- ^ Dhurat R, Saraogi P. Hair evaluation methods: merits and demerits. Int J Trichology. 2009;1(2):108-19.
- ^ Herskovitz I, Tosti A. Female pattern hair loss. Int J Endocrinol Metab. 2013;11(4):e9860.
- ^ Vañó-galván S, Molina-ruiz AM, Serrano-falcón C, et al. Frontal fibrosing alopecia: a multicenter review of 355 patients. J Am Acad Dermatol. 2014;70(4):670-8.
- ^ Pirmez R, Duque-Estrada B, Barreto T, Quintella DC, Cuzzi T. Successful Treatment of Facial Papules in Frontal Fibrosing Alopecia with Oral Isotretinoin. Skin Appendage Disord 2017;3:111-113. doi=10.1159/000464334
External links
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