Frontal Fibrosing Alopecia – Case Studies and Review

Frontal fibrosing alopecia (FFA) was described as a scarring alopecia marked by the regression of the frontotemporal hairline, presence of "lonely hairs," and eyebrow loss. It predominantly affected postmenopausal women, though younger women and men were also occasionally affected. The progression of FFA varied, often being slow and unnoticed, with spontaneous remissions occurring. The incidence appeared to be increasing, potentially due to environmental factors, sunscreen use, or better awareness and diagnostics. The exact cause of the lymphocytic follicular inflammation remained unclear. Clinically, affected skin was atrophic and pale, with follicular erythemas and keratoses in inflamed areas, and small pale, reddish papules on the forehead and cheeks were common. No approved treatments existed, but local corticosteroids, calcineurin inhibitors, and minoxidil were used, along with systemic treatments like 5α-reductase inhibitors, hydroxychloroquine, and doxycycline.