An Update of the Pathogenesis of Frontal Fibrosing Alopecia: What Does the Current Evidence Tell Us?

The document from 2018 reviews the complex pathogenesis of frontal fibrosing alopecia (FFA), highlighting the role of immune-mediated inflammation, genetic predisposition, hormonal influences, and potential environmental triggers. It notes that Th1-mediated inflammation, PPAR-y depletion, and epithelial-mesenchymal transition are key in the destruction of hair follicles. The condition's association with postmenopausal women and its coexistence with pattern hair loss in both genders suggest hormonal factors, with some response to 5x-reductase inhibitors. A retrospective review included 343 women and 12 men, indicating a significant overlap with pattern hair loss. The review underscores the lack of conclusive evidence for environmental triggers like sun exposure and calls for more research to fully understand FFA and develop effective treatments.