Frontal Fibrosing Alopecia Preceding the Development of Vitiligo: A Case Report

January 2020 in “ JAAD case reports ”

Brianna De Souza, Lindsay H. Burns, Maryanne M. Senna

frontal fibrosing alopecia scarring alopecia inflammation hair loss lichen planopilaris hair follicular stem cells inflammatory response FFA LPP

TLDR Hair loss condition FFA was seen before the appearance of skin depigmentation vitiligo in a patient.

This case report described a 43-year-old Egyptian woman with frontal fibrosing alopecia (FFA) who developed vitiligo, an unusual sequence as vitiligo typically precedes scarring alopecia. The patient experienced rapid hair loss following the appearance of a depigmented lesion, likely triggered by paraphenylenediamine (PPD) in hair dye. Histologic findings confirmed FFA, and clinical observations supported chemical-induced vitiligo. The case suggested that FFA might precede vitiligo due to an indolent inflammatory process that intensifies, leading to follicular stem cell destruction and melanocyte loss. This challenges previous theories and underscores the complex relationship between these conditions, necessitating further research.

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Research cited in this study

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research Hypopigmentation in Frontal Fibrosing Alopecia

23 citations, May 2017 in “Journal of the American Academy of Dermatology”

FFA patients have fewer melanocytes and thinner skin compared to others.

research Frontal Fibrosing Alopecia: A Retrospective Clinical Review of 62 Patients with Treatment Outcome and Long-Term Follow-Up

102 citations, April 2014 in “International Journal of Dermatology”

The treatment helped reduce symptoms and stabilize the hairline in most patients with Frontal Fibrosing Alopecia, but hair regrowth was limited.

research Frontal Fibrosing Alopecia: A Multicenter Review of 355 Patients

339 citations, February 2014 in “Journal of The American Academy of Dermatology”

Most patients with frontal fibrosing alopecia are postmenopausal women, and treatments like finasteride and dutasteride can improve or stabilize the condition.

research Frontal Fibrosing Alopecia: Clinical Presentations and Prognosis

155 citations, September 2008 in “British journal of dermatology/British journal of dermatology, Supplement”

FFA is more common in postmenopausal women, can affect younger women, and may stabilize over time.

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