Frontal Fibrosing Alopecia: A Review

April 2021 in “ Journal of Clinical Medicine ”

María Librada Porriño‐Bustamante, María Antonia Fernández‐Pugnaire, Salvador Arias‐Santiago

Frontal Fibrosing Alopecia scarring alopecia postmenopausal women hormonal factors autoimmune factors genetic factors environmental factors hairline recession eyebrow alopecia trichoscopy sonography histopathology CD8+ T cell infiltration 5-alpha reductase inhibitors finasteride dutasteride FFA Propecia Avodart

From the encyclopedia

Finasteride →

Frontline, gold standard treatment for combatting androgenic alopecia

Dutasteride →

Heavy duty finasteride that comes with higher risks

Studysummary This review compiles existing data on frontal fibrosing alopecia and highlights the promise of 5-alpha reductase inhibitors as a treatment option, while noting the need for clarity on its cause and progression.

Automatically generated from the study's abstract, not written by a person, and not a review of the full paper. Not medical advice or a treatment recommendation. Read the original study, and consult a qualified healthcare professional before changing treatment. Full disclaimer

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Research cited in this study

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research Medical Comorbidities and Sex Distribution Among Patients With Lichen Planopilaris and Frontal Fibrosing Alopecia: A Retrospective Cohort Study

22 citations , August 2020 in “Journal of the American Academy of Dermatology”

Women with lichen planopilaris and frontal fibrosing alopecia often have other health issues like hypothyroidism and lupus.

Clinical Characteristics, Trichoscopy, Histopathology, and Treatment Outcomes of Frontal Fibrosing Alopecia in an Asian Population: A Retro-Prospective Cohort Study

research Clinical Characteristics, Trichoscopy, Histopathology, and Treatment Outcomes of Frontal Fibrosing Alopecia in an Asian Population: A Retro-Prospective Cohort Study

9 citations , July 2020 in “Journal of Dermatology”

This study found that diffuse and pseudo-fringe sign patterns are common in Asian patients with frontal fibrosing alopecia, and that treatments combining antiandrogens or antimalarials with topical therapy are effective.

research Frontal Fibrosing Alopecia: An Example of Disrupted Aryl Hydrocarbon Receptor-Mediated Immunological Homeostasis in the Skin?

8 citations , July 2020 in “Clinical, cosmetic and investigational dermatology”

This review hypothesizes that excessive facial photo-protection may contribute to frontal fibrosing alopecia by disrupting immunological homeostasis through the aryl hydrocarbon receptor-kynurenine pathway, but it reports no new clinical results.

research Frontal Fibrosing Alopecia Shows Robust T Helper 1 and Janus Kinase 3 Skewing

34 citations , June 2020 in “British journal of dermatology/British journal of dermatology, Supplement”

In this study, researchers observed that follicular damage and stem cell loss in frontal fibrosing alopecia may be mediated by immune attacks at the bulge region, suggesting potential for JAK/STAT-targeting treatments to prevent progression.

research Recalcitrant Lichen Planopilaris and Frontal Fibrosing Alopecia Responding to Tildrakizumab

10 citations , May 2020 in “Dermatologic therapy”

In this study, a patient with recalcitrant lichen planopilaris and frontal fibrosing alopecia showed significant improvement after receiving four doses of the interleukin-23 monoclonal antibody tildrakizumab.

research Association of Inflammation With Progression of Hair Loss in Women With Frontal Fibrosing Alopecia

16 citations , April 2020 in “JAMA dermatology”

More inflammation leads to faster and worse hair loss in women with frontal fibrosing alopecia.

research Oral Minoxidil Improves Background Hair Thickness in Lichen Planopilaris

15 citations , April 2020 in “Journal of The American Academy of Dermatology”

This article discusses the challenges of treating lichen planopilaris, reviews various therapeutic options including minoxidil, and reports no new clinical findings.

Oral Isotretinoin Combined with Topical Clobetasol 0.05% and Tacrolimus 0.1% for the Treatment of Frontal Fibrosing Alopecia: A Randomized Controlled Trial

research Oral Isotretinoin Combined with Topical Clobetasol 0.05% and Tacrolimus 0.1% for the Treatment of Frontal Fibrosing Alopecia: A Randomized Controlled Trial

11 citations , April 2020 in “Journal of Dermatological Treatment”

This study found that combining oral isotretinoin with topical treatments was more effective than topical treatments alone for improving frontal fibrosing alopecia symptoms, despite some side effects.

research A Novel Atypical Presentation of Frontal Fibrosing Alopecia Involving the Frontoparietal Scalp

4 citations , January 2020 in “Skin appendage disorders”

This case report describes a unique presentation of frontal fibrosing alopecia characterized by a hair loss pattern that resembles the Greek letter upsilon, supported by trichoscopic and histological findings.

research Frontal Fibrosing Alopecia in Asians: A Retrospective Clinical Study

8 citations , October 2019 in “International Journal of Dermatology”

This study examined 56 Thai patients with frontal fibrosing alopecia, finding frontotemporal hairline recession and eyebrow loss were common, and reported better disease stabilization with combination treatments of topical corticosteroids with hydroxychloroquine or finasteride.

research Increased Preauricular Wrinkles in Frontal Fibrosing Alopecia Compared to Age-Matched Controls: A Prospective Study of 64 Patients

3 citations , September 2019 in “Skin appendage disorders”

This study found that females with frontal fibrosing alopecia had more preauricular lines than age-matched controls, indicating a potential new clinical marker for the condition.

research Platelet-Rich Plasma for Treatment-Resistant Frontal Fibrosing Alopecia: A Case Report

15 citations , August 2019 in “Dermatologic Therapy”

This letter details a case report on platelet-rich plasma treatment for a patient with treatment-resistant frontal fibrosing alopecia, but it does not provide new clinical results.

research Frontal Fibrosing Alopecia Involving the Limbs Shows Inflammatory Pattern on Histology: A Review of 13 Cases

7 citations , August 2019 in “American Journal of Dermatopathology”

This study found that limb hair loss in frontal fibrosing alopecia is inflammatory and permanent, but lacks the classic scarring features seen in scalp alopecia, prompting potential misdiagnosis as alopecia areata.

research Successful Treatment of Frontal Fibrosing Alopecia with Alitretinoin

9 citations , July 2019 in “Dermatologic therapy”

In this case report, a patient with frontal fibrosing alopecia and lichen planus responded well to treatment with alitretinoin, suggesting a potential therapeutic role for alitretinoin in similar cases.

research Frontal Fibrosing Alopecia: Demographic and Clinical Characteristics of 490 Cases

53 citations , June 2019 in “JEADV. Journal of the European Academy of Dermatology and Venereology/Journal of the European Academy of Dermatology and Venereology”

This study observed that abnormal hormone levels were associated with lower disease activity in frontal fibrosing alopecia, while thyroid disorders were a common comorbidity among the affected population.

research Familial Frontal Fibrosing Alopecia in Two Male Families

6 citations , June 2019 in “International Journal of Dermatology”

This article discusses familial frontal fibrosing alopecia in two male families and reports no new clinical findings.

research Genome-Wide Association Study in Frontal Fibrosing Alopecia Identifies Four Susceptibility Loci Including HLA-B*07:02

115 citations , March 2019 in “Nature Communications”

This study identified significant genetic associations with frontal fibrosing alopecia at four genomic loci, suggesting it is a genetically predisposed immuno-inflammatory disorder influenced by the HLA-B*07: 02 allele.

Study of Human Leukocyte Antigen in 13 Cases of Familial Frontal Fibrosing Alopecia: CYP21A2 Gene p.V281L Mutation from Congenital Adrenal Hyperplasia Linked to HLA Class I Haplotype HLA-A*33:01; B*14:02; C*08:02 as a Genetic Marker

research Study of Human Leukocyte Antigen in 13 Cases of Familial Frontal Fibrosing Alopecia: CYP21A2 Gene p.V281L Mutation from Congenital Adrenal Hyperplasia Linked to HLA Class I Haplotype HLA-A33:01; B14:02; C*08:02 as a Genetic Marker

7 citations , January 2019 in “Australasian Journal of Dermatology”

In this study, the CYP 21A2 gene p.V281L mutation was associated with an increased susceptibility to familial frontal fibrosing alopecia, suggesting an antigen-driven mechanism linked to certain human leukocyte antigen haplotypes.

Adipose Infiltration of the Dermis, Involving the Arrector Pili Muscle, and Dermal Displacement of Eccrine Sweat Coils: New Histologic Observations in Frontal Fibrosing Alopecia

research Adipose Infiltration of the Dermis, Involving the Arrector Pili Muscle, and Dermal Displacement of Eccrine Sweat Coils: New Histologic Observations in Frontal Fibrosing Alopecia

6 citations , January 2019 in “The American Journal of Dermatopathology”

This study discovered that adipose tissue infiltration at the isthmus level appears significantly more often in frontal fibrosing alopecia cases compared to controls, suggesting a potential role in the condition's pathology.

research Onset of Frontal Fibrosing Alopecia During Inhibition of Th1/17 Pathways with Ustekinumab

7 citations , January 2019 in “Dermatology Online Journal”

In this case report, a 62-year-old woman's persistent frontal fibrosing alopecia while on the psoriasis medication ustekinumab suggests that IL-12 and IL-23 inhibition may not be effective in treating this scarring alopecia, challenging the role of Th1 and Th17 pathways in its pathogenesis.

research Social Status May Interfere in the Prognosis of Frontal Fibrosing Alopecia in Female Patients: An Observational Study

2 citations , January 2019 in “Skin appendage disorders”

This study observed that women with higher educational levels and social status are diagnosed with frontal fibrosing alopecia earlier, resulting in better therapeutic responses.

research Frequency of the Types of Alopecia at Twenty-Two Specialist Hair Clinics: A Multicenter Study

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This study found that women with frontal fibrosing alopecia have a significantly higher prevalence of rosacea compared to controls, particularly those with severe alopecia, and certain factors like perifollicular erythema, higher BMI, and lower progesterone levels were linked to increased rosacea risk.

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The authors concluded that Hispanic/Latino ethnicity, facial papules, and premenopausal status in patients with frontal fibrosing alopecia may indicate a susceptibility to more severe disease, potentially necessitating early treatment.

research Familial Frontal Fibrosing Alopecia: A Cross-Sectional Study of 20 Cases from Nine Families

8 citations , November 2018 in “Australasian Journal of Dermatology”

This study adds evidence suggesting a genetic component to frontal fibrosing alopecia, with daughters experiencing an earlier onset than their mothers, although the clinical pattern remains similar to non-familial cases.

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79 citations , September 2018 in “Dermatologic therapy”

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research A New Histologic Pattern in 6 Biopsies From Early Frontal Fibrosing Alopecia

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24 citations , July 2018 in “British Journal of Dermatology”

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research Frontal Fibrosing Alopecia: Regrowth Following Cessation of Sunscreen on the Forehead

26 citations , June 2018 in “Australasian Journal of Dermatology”

Stopping sunscreen use on the forehead led to hair regrowth in a woman with frontal fibrosing alopecia.

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19 citations , April 2018 in “International Journal of Dermatology”

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80 citations , April 2018 in “Trends in Molecular Medicine”

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18 citations , February 2018 in “Journal of the American Academy of Dermatology”

This study reports no new clinical results but suggests a potential relationship between frontal fibrosing alopecia and cutaneous conditions such as rosacea, indicating a need for further research.

research Frontal Fibrosing Alopecia After Antiandrogen Hormonal Therapy in a Male Patient

9 citations , January 2018 in “Journal of the European Academy of Dermatology and Venereology”

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research Lichen Planopilaris Caused by Wig Attachment: A Case of Koebner Phenomenon in Frontal Fibrosing Alopecia

7 citations , January 2018 in “International Journal of Trichology”

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research Case Report of Connubial Frontal Fibrosing Alopecia

6 citations , January 2018 in “International Journal of Trichology”

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research Frontal Fibrosing Alopecia: A Retrospective Analysis of 72 Patients from a German Academic Center

25 citations , December 2017 in “Facial Plastic Surgery”

This study observed that combining high-potency steroids with pimecrolimus might effectively stabilize hairline recession in frontal fibrosing alopecia patients.

research Prognosis, Treatment, and Disease Outcomes in Frontal Fibrosing Alopecia: A Retrospective Review of 92 Cases

36 citations , December 2017 in “Journal of the American Academy of Dermatology”

This study observed that 70.7% of patients with frontal fibrosing alopecia stabilized with treatment, and patients using 0.3% tacrolimus were more likely to stabilize in 3 months compared to other treatments.

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8 citations , December 2017 in “Journal of The American Academy of Dermatology”

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research Updated Diagnostic Criteria for Frontal Fibrosing Alopecia

30 citations , December 2017 in “Journal of The American Academy of Dermatology”

This correspondence discusses proposed updates to the diagnostic criteria for frontal fibrosing alopecia, emphasizing the importance of differentiating it from other types of alopecia.

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research Is There a Pathogenetic Link Between Frontal Fibrosing Alopecia, Androgenetic Alopecia, and Fibrosing Alopecia in a Pattern Distribution?

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This letter discusses potential pathogenetic links among frontal fibrosing alopecia, androgenetic alopecia, and fibrosing alopecia in a pattern distribution and reports no new clinical findings.

research The Increasing Incidence of Frontal Fibrosing Alopecia: In Search of Triggering Factors

21 citations , October 2017 in “Journal of the European Academy of Dermatology and Venereology”

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32 citations , September 2017 in “Journal of the American Academy of Dermatology”

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research Tissue and Circulating MicroRNA Co-expression Analysis Shows Potential Involvement of miRNAs in the Pathobiology of Frontal Fibrosing Alopecia

8 citations , July 2017 in “The journal of investigative dermatology/Journal of investigative dermatology”

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research Unusual Patterns of Presentation of Frontal Fibrosing Alopecia: A Clinical and Trichoscopic Analysis of 98 Patients

18 citations , June 2017 in “Journal of The American Academy of Dermatology”

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research Frontal Fibrosing Alopecia: Clinical and Prognostic Classification

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This study classified frontal fibrosing alopecia patients into three clinical patterns, finding that pattern III had the best prognosis and pattern II the worst after treatment with dutasteride and corticosteroids.

research Prevalence of Hormonal and Endocrine Dysfunction in Patients with Lichen Planopilaris: A Retrospective Data Analysis of 168 Patients

44 citations , February 2017 in “Journal of the American Academy of Dermatology”

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research DHEA and Frontal Fibrosing Alopecia: Molecular and Physiopathological Mechanisms

31 citations , December 2016 in “Anais Brasileiros de Dermatologia”

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research Frontal Fibrosing Alopecia in Men: Presentation of 12 Cases and Literature Review

26 citations , August 2016 in “Actas Dermo-Sifiliográficas”

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3 citations , June 2016 in “JEADV. Journal of the European Academy of Dermatology and Venereology/Journal of the European Academy of Dermatology and Venereology”

This letter to the editor describes a case of postcast hypertrichosis in a patient with frontal fibrosing alopecia and reports no new research findings.

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62 citations , May 2016 in “British journal of dermatology/British journal of dermatology, Supplement”

research Frontal Fibrosing Alopecia: Reflections and Hypotheses on Etiology and Pathogenesis

68 citations , May 2016 in “Experimental dermatology”

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research Isolated Eyebrow Loss in Frontal Fibrosing Alopecia: Relevance of Early Diagnosis and Treatment

27 citations , May 2016 in “British journal of dermatology/British journal of dermatology, Supplement”

research Frontal Fibrosing Alopecia and Vitiligo: Coexistence or True Association

31 citations , January 2016 in “Skin Appendage Disorders”

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research Finasteride-Mediated Hair Regrowth and Reversal of Atrophy in a Patient with Frontal Fibrosing Alopecia

24 citations , September 2015 in “JAAD case reports”

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39 citations , July 2015 in “British Journal of Dermatology”

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research Case Series of Familial Frontal Fibrosing Alopecia and a Review of the Literature

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research Trichoscopic Features of Frontal Fibrosing Alopecia: Results in 249 Patients

46 citations , January 2015 in “Journal of The American Academy of Dermatology”

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This case report describes a 67-year-old woman with frontal fibrosing alopecia and her daughter with lichen planopilaris, noting identical HLA D types which suggest a phenotypical link between these conditions.

research Nail Involvement in Frontal Fibrosing Alopecia

17 citations , January 2015 in “International Journal of Trichology”

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

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research Beard Involvement in a Man with Frontal Fibrosing Alopecia

14 citations , January 2014 in “Indian Journal of Dermatology Venereology and Leprology”

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33 citations , October 2013 in “Journal of The American Academy of Dermatology”

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research Absence of Vellus Hair in the Hairline: A Videodermatoscopic Feature of Frontal Fibrosing Alopecia

33 citations , August 2013 in “British Journal of Dermatology”

Lack of small, fine hair on the front hairline is a key sign of frontal fibrosing alopecia.

research Lichen Planopilaris Is Characterized By Immune Privilege Collapse Of The Hair Follicle's Epithelial Stem Cell Niche

220 citations , June 2013 in “The Journal of Pathology”

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research Is Hair Transplantation Indicated in Frontal Fibrosing Alopecia? The Results of Test Grafting in Three Patients

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research Frontal Fibrosing Alopecia: A Retrospective Review of 19 Patients Seen at Duke University

98 citations , January 2013 in “Journal of The American Academy of Dermatology”

This study reported that while various treatments for frontal fibrosing alopecia showed limited effectiveness, dutasteride most effectively stabilized the condition among patients at Duke University.

research Perifollicular Erythema as a Trichoscopy Sign of Progression in Frontal Fibrosing Alopecia

40 citations , January 2013 in “International journal of trichology”

This study found that among women with frontal fibrosing alopecia, 100% showed dermoscopic elements suggestive of the condition, with perifollicular erythema often indicating disease activity.

research Frontal Fibrosing Alopecia and Lichen Planus Pigmentosus: Is There a Link?

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42 citations , July 2012 in “PLOS ONE”

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research Frontal Fibrosing Alopecia: A Review of 60 Cases

166 citations , April 2012 in “Journal of The American Academy of Dermatology”

This study reviewed clinical data from 60 patients with frontal fibrosing alopecia and found increasing prevalence and generally poor response to treatment, with the cause remaining unclear.

research Trichoscopy Update 2011

178 citations , December 2011 in “Journal of Dermatological Case Reports”

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research Lonely Hair

63 citations , October 2011 in “Archives of Dermatology”

Isolated long hairs at the original hairline can help diagnose Frontal Fibrosing Alopecia.

research Hair Loss Due to Lichen Planopilaris After Hair Transplant: Case Reports and Literature Review

22 citations , April 2011 in “Anais Brasileiros de Dermatologia”

This report describes two cases where lichen planopilaris may have compromised the hair follicles in both donor and recipient areas following follicular unit transplantation.

research Eyebrow Regrowth in Patients with Frontal Fibrosing Alopecia Treated with Intralesional Triamcinolone Acetonide

51 citations , August 2010 in “British journal of dermatology/British journal of dermatology, Supplement”

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research Frontal Fibrosing Alopecia: A Clinical Review of 36 Patients

159 citations , August 2010 in “British journal of dermatology/British journal of dermatology, Supplement”

In this study, hydroxychloroquine significantly reduced signs and symptoms of frontal fibrosing alopecia after 6 months of treatment, with maximal benefits observed within the first 6 months.

research Frontal Fibrosing Alopecia in a Man: Results of Follicular Unit Test Grafting

53 citations , May 2010 in “Dermatologic Surgery”

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research Expression of Snail1 in the Fibrotic Dermis of Postmenopausal Frontal Fibrosing Alopecia: Possible Involvement of an Epithelial-Mesenchymal Transition and a Review of Japanese Patients

29 citations , February 2010 in “British Journal of Dermatology”

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105 citations , December 2009 in “Archives of dermatology”

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research Treatment of Postmenopausal Frontal Fibrosing Alopecia with Oral Dutasteride

64 citations , June 2009 in “Journal of The American Academy of Dermatology”

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research Frontal Fibrosing Alopecia: Clinical Presentations and Prognosis

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

This study observed that frontal fibrosing alopecia predominantly affects postmenopausal women, can be associated with lichen planus, and may lead to progressive hairline recession, though this progression is not consistent in all cases.

research Frontal Fibrosing Alopecia: Treatment with Oral Dutasteride and Topical Pimecrolimus

69 citations , August 2008 in “Journal of The European Academy of Dermatology and Venereology”

Oral dutasteride and topical pimecrolimus can safely and effectively treat Frontal Fibrosing Alopecia, leading to significant hair regrowth.

research The Surgical Treatment of Cicatricial Alopecia

51 citations , July 2008 in “Dermatologic Therapy”

This article proposes two new categories of cicatricial alopecia—“unstable” and “stable”—and suggests surgical excision as preferred over hair transplantation, especially for unstable cases.

research Frontal Fibrosing Alopecia: Diagnostic and Therapeutic Assessment

54 citations , November 2007 in “Actas Dermo-Sifiliográficas”

Early diagnosis of frontal fibrosing alopecia is crucial to prevent permanent hair loss.

research Frontal Fibrosing Alopecia Versus Lichen Planopilaris: A Clinicopathological Study

126 citations , April 2006 in “International Journal of Dermatology”

This study found that frontal fibrosing alopecia and lichen planopilaris have similar histopathological features, but FFA exhibits more prominent apoptosis and less inflammation with spared interfollicular epidermis.

research Frontal Fibrosing Alopecia: A Survey in 16 Patients

123 citations , August 2005 in “Journal of the European Academy of Dermatology and Venereology”

In this study, the researchers observed that treatment with intralesional and topical corticosteroids, finasteride, and minoxidil may stop the progression of frontal fibrosing alopecia in postmenopausal and premenopausal women.

research Frontal Fibrosing Alopecia Developing After Hair Transplantation for Androgenetic Alopecia

64 citations , January 2005 in “International Journal of Dermatology”

This report discusses cases of frontal fibrosing alopecia developing after hair transplantation for androgenetic alopecia, without presenting new clinical findings.

research Frontal Fibrosing Alopecia in Postmenopausal Women

179 citations , December 2004 in “Journal of The American Academy of Dermatology”

This study observed that frontal fibrosing alopecia in postmenopausal women involves selective follicular inflammation, and finasteride treatment may slow disease progression, suggesting a potential androgen-related component.

research Frontal Fibrosing Alopecia Associated with Cutaneous Lichen Planus in a Premenopausal Woman

89 citations , February 2002 in “Australasian journal of dermatology”

This case report describes the first known instance of fibrosing alopecia associated with cutaneous lichen planus, suggesting fibrosing alopecia may be a variant of lichen planopilaris.

research Postmenopausal Frontal Fibrosing Alopecia: A Frontal Variant of Lichen Planopilaris

329 citations , January 1997 in “Journal of the American Academy of Dermatology”

This study reports that progressive frontal fibrosing alopecia, a distinct and gradually stabilizing form of lichen planopilaris affecting elderly women and often involving eyebrow hair loss, lacks effective treatments.

research Postmenopausal Frontal Fibrosing Alopecia

325 citations , June 1994 in “Archives of Dermatology”

This study observed that progressive frontal recession in postmenopausal women may exhibit features of fibrosing alopecia, suggesting a distinct reaction pattern from typical lichen planopilaris.