Frontal Fibrosing Alopecia: Just Lichen Planopilaris?

The document discusses whether Frontal Fibrosing Alopecia (FFA) is merely a distinct form of Lichen Planopilaris (LPP) or a more complex disorder. FFA is characterized by a symmetrical recession of the frontal hairline, mainly in post-menopausal women, and is histologically indistinguishable from LPP, showing prominent perifollicular fibrosis and lymphocytic inflammation without gross scarring. The author, Steven Kossard, suggests that FFA may be linked to gender-based differences in patterned hair loss and hormonal changes associated with menopause. He hypothesizes that women with FFA might carry genes for a male pattern hair loss subtype, which becomes active post-menopause due to changes in sex hormone profiles affecting follicular receptors. This could trigger a targeted lymphocytic response leading to follicle destruction, potentially starting with the eyebrows before the frontal hairline. Kossard argues that the term FFA should not be discarded as it captures the hormonal aspect of the condition, and further research should explore this complex form of alopecia, which may extend beyond being just LPP.