Postmenopausal Frontal Fibrosing Alopecia: A Frontal Variant of Lichen Planopilaris

The study examined the clinical and histopathologic features of frontal fibrosing alopecia (FFA), a condition affecting postmenopausal women characterized by progressive hair loss at the frontal hairline, which is a variant of lichen planopilaris. The study included 16 women with FFA, 13 of whom also experienced significant eyebrow loss. No other sites of lichen planus were found, except in one patient who developed multifocal lichen planopilaris. The condition was slowly progressive, with stabilization observed in five patients. Histologic examination of scalp biopsies from the frontal hairline showed changes identical to those seen in lichen planopilaris, and immunophenotyping showed no significant differences between FFA and the multifocal variant. Treatments, including oral steroids, antimalarials, and hormone replacement therapy, were largely ineffective, though some may temporarily slow progression. The underlying cause of the condition remains unknown.