Post-menopausal frontal fibrosing alopecia

The document reports on post-menopausal frontal fibrosing alopecia (PFFA), a condition characterized by symmetrical hair loss in the fronto-temporal areas of the scalp and eyebrows, primarily affecting postmenopausal women. Two cases from the UK are presented, with both patients showing progressive hair loss and clinical signs such as alopecia with loss of follicles, prominent follicles with perifollicular erythema, and no dystrophic hairs or scaling. Histological examination revealed inflammatory changes, destruction of hair follicles, perifollicular fibrosis, and a lichenoid reaction, leading to a diagnosis of PFFA. Treatments with potent topical steroids did not significantly reduce erythema or halt the progression of the disease over 6 months. PFFA is similar to lichen planopilaris (LPP) but can be distinguished by its distinct distribution and progression. The cause of PFFA is unknown, and it does not respond well to conventional treatments, though the condition may eventually burn out. The document suggests that early presentation with minimal scarring might benefit from treatment with topical tacrolimus.