Frontal fibrosing alopecia
Frontal fibrosing alopecia describes hair loss and scarring in the frontal region of the scalp.
What are its features?
Frontal fibrosing alopecia usually affects post-menopausal women over the age of 50. It is characterised by usually symmetrical band of hair loss on the front and sides of the scalp, and loss of eyebrows. The edge may appear moth-eaten, and single hairs may persist in the bald areas.
The skin in the affected area usually looks normal but may be pale, shiny or mildly scarred. Close inspection shows redness and scaling around hair follicles at the margins of the bald areas.
What is the cause of frontal fibrosing alopecia?
The exact cause of frontal fibrosing alopecia is unknown. It is thought to be due to disturbed immune response to some component of the intermediate-sized and vellus scalp hair follicles. The onset after menopause suggests there may be a hormonal component.
Skin biopsy findings
A skin biopsy examination in the laboratory helps in making the diagnosis. The newly affected hair follicles are surrounded by a lichenoid pattern of inflammation associated with scarring. The histopathological features are identical to those of lichen planopilaris.
Course and prognosis
Usually frontal fibrosing alopecia is slowly progressive. In a few patients it stabilises after a few years.
Treatment of frontal fibrosing alopecia
There is no effective treatment available as yet. A short course of oral steroids, antiinflammatory antibiotics such as tetracyclines, or antimalarial tablets may benefit patients who have a rapid onset of hair loss. The 5-alpha reductase inhibitors finasteride and dutasteride have been reported to stop further hair loss in some women.