Frontal Fibrosing Alopecia in Black Women: Clinical, Diagnostic, and Therapeutic Aspects

The study focuses on frontal fibrosing alopecia (FFA) in Black women, highlighting its unique clinical and epidemiological features. FFA is a scarring alopecia characterized by progressive hairline recession and eyebrow thinning. Although initially noted in postmenopausal white women, there is a rising incidence in Black women, who are underrepresented in research, leading to diagnostic delays. In Black women, FFA may present with perifollicular hyperpigmentation and hair thinning patterns similar to traction or androgenetic alopecia, complicating diagnosis. The condition's multifactorial etiology includes genetic, autoimmune, hormonal, and environmental factors, with hair care practices like chemical relaxers and tight hairstyles potentially triggering inflammation. Diagnosis requires a combined approach, emphasizing dermoscopy and biopsy, which reveals lymphocytic infiltrate and perifollicular fibrosis. Differential diagnoses include traction alopecia, chronic cutaneous lupus erythematosus, and lichen planopilaris. Early diagnosis is crucial for effective treatment, which may involve topical or intralesional corticosteroids, antimalarials, 5α-reductase inhibitors, and systemic immunomodulators. Complementary therapies like oral retinoids and excimer laser can enhance outcomes. For Black women, less aggressive hair care practices are advised, and early diagnosis significantly improves prognosis, underscoring the need for specific protocols and inclusive research.