Frontal Fibrosing Alopecia: A Review

Frontal Fibrosing Alopecia (FFA) is a scarring alopecia with an increasing prevalence, primarily affecting postmenopausal women but also seen in men and premenopausal women. The review, which examined 487 articles published between 1994 and 2021, found that FFA's etiology is not fully understood but may involve hormonal, autoimmune, genetic, and environmental factors. The disease is most common in Caucasians and presents with a range of clinical patterns, including hairline recession and eyebrow alopecia. Diagnosis relies on trichoscopy, sonography, and histopathology, with a characteristic reduction in hair follicles and increased CD8+ T cell infiltration observed. Treatment aims to alleviate symptoms and prevent further hair loss, as regrowth is not possible once follicles are destroyed. Oral 5-alpha reductase inhibitors like finasteride and dutasteride have shown the most promise, with a study of 224 patients indicating a significant stabilization rate with dutasteride. However, the review emphasizes the need for further research into new treatments.