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

The authors of this letter to the editor report on the frequent coexistence of frontal fibrosing alopecia (FFA) and androgenetic alopecia (AGA) in women, and suggest that these conditions might be pathogenetically related. They conducted a study of 35 female patients diagnosed with FFA, and found that 57% of them also had AGA. They suggest that the lichenoid reaction leading to follicular destruction in patients with FFA might be pathogenetically related to the events underlying AGA, and that an androgen-related antigenic stimulus may initiate a lichenoid reaction in an immunogenetically susceptible individual. They also discuss the overlap of FFA, AGA, and fibrosing alopecia in a pattern distribution (FAPD) in some patients, and suggest that FFA could represent a scarring variant of AGA.