Frontal Fibrosing Alopecia

Hair loss is a natural part of the hair growth cycle, but it can be an upsetting time.  Fibrosing alopecia is a hair loss condition that causes permanent damage to the hair follicles. It’s also known as lichen planopilaris. Read on to find out more about hair loss and how it’s treated.

The disease starts in one area on the scalp, but it can progress to other areas and cause widespread baldness.

What is Frontal Fibrosing Alopecia? 

It’s a rare form of alopecia that is often misdiagnosed, but there are things you can do to help combat the disease. Commonly known as fibrosis, it affects each and every organ in the body of an individual. Fibrosis is often characterized by a thickening or scarring of the organs in a person’s body. There are many forms of fibrosis that affect an individual, some forms are so mild that the person who has them may not even know that they suffer from a disorder or condition.

Frontal fibrosing alopecia (FFA) is a patterned form of scarring and hair loss along the forehead scalp hair border. The symmetrical frontal hair loss characteristic of androgenetic alopecia affects women after menopause and is characterized by a band of symmetric posterior hair loss that gradually expands forward. The condition was first identified in a group of Australian women in 1994.

FFA typically spares the upper central scalp, but the more severe cases show more extensive involvement of this area. The extent of hair loss may be limited to the frontal scalp, but the majority of patients have some involvement of the vertex and/or occipital regions, which is usually less pronounced than seen in frontotemporal areas.

Causes of Frontal Fibrosing Alopecia: 

After extensive research, researchers have found that FFA can affect anyone, including men and children, as well as all ethnic groups.Although the typical patient with frontal fibrosing alopecia is described as a Caucasian post-menopausal woman over the age of 50, younger women and ethnic minorities can also be afflicted.

The pathogenesis of FFA is still unknown; however, there are many theories on why it occurs. Some believe that FFA may be hereditary while others believe it could be triggered by environmental factors such as hormonal changes or infectious agents (bacteria or viruses).

In addition to age and ethnicity, there are some other factors that may play a role in developing FFA such as genetic predisposition or chronic inflammation due to an underlying illness like lupus erythematosus (LE) or sarcoidosis. The symptoms of frontal fibrosing alopecia vary from person to person.

The first sign is often an itchy or painful scalp, with a rash along your hairline, face, or scalp. You may also lose your eyebrows.

As the condition progresses, you may see a receding hairline that spreads over time. You may notice small, raised bumps on your face or hair loss on your arms and legs. If you have white hairs, they may start turning brown or gray. Although this condition may sound daunting, there are medications that may help slow this down, especially if caught early.

Diagnosis of Frontal Fibrosing Alopecia : 

Your dermatologist will examine your hairline, scalp, and eyebrows closely. They’ll ask how long you’ve noticed the hair loss and whether you have symptoms like itchiness or pain. They’ll also ask if you have hair loss on any other part of your body. Your dermatologist will also talk with you about your health, medical conditions, and medications to determine if there’s any cause for your hair loss beyond frontal fibrosing alopecia.

They will probably suspect frontal fibrosing alopecia based on your signs and symptoms. But in order to confirm the diagnosis, he or she may take a small skin sample (biopsy) from the affected area.

In some cases, they may decide to run laboratory studies, too, so that they can rule out other conditions that cause similar symptoms.

Treatment of Frontal Fibrosing Alopecia: 

Your dermatologist will customize a treatment plan to fit your needs. Most treatment plans use a combination of therapies, as this tends to give patients the best outcome.

  • Finasteride or dutasteride – Finasteride or dutasteride are two medications that were first used to treat prostate enlargement (also known as benign prostatic hyperplasia [BPH]), but are now also used for male-pattern baldness. These medications work by blocking an enzyme in your body called 5-alpha reductase. The enzyme changes testosterone into dihydrotestosterone (DHT), which causes the prostate gland and hair follicles to get smaller over time. By blocking this process, finasteride and dutasteride allow them to remain at their larger size, resulting in fewer symptoms of BPH and slowing or stopping thinning of the hair on your scalp.
  • Corticosteroids – These are effective in treating frontal fibrosing alopecia in some people but not all people. Corticosteroids are available in several different forms, including creams and ointments you apply directly to your skin, lotions you rub into your scalp, and oral medications (pills) you swallow. If you’re taking an oral corticosteroid, your doctor will probably monitor your blood.
  • Hydroxychloroquine– Hydroxychloroquine (Plaquenil) is an anti-malarial drug that has been used successfully over many years in the treatment of a variety of skin conditions, including alopecia areata, frontal fibrosing alopecia, and lichen planus pigmentosus. It is often used in combination with topical minoxidil. It can be given orally or intravenously. It is usually taken once daily orally. Some patients experience an upset stomach with this medication but do not tend to discontinue it because of its effectiveness in treating their condition.
  • Laser Therapy–  Laser therapy is a low-level light therapy that targets the hair follicles on the scalp and stimulates them to produce thicker hair. Treatment typically requires one or two weekly sessions in order to see results, which can be maintained by monthly treatments. A certified medical professional will administer the treatment in a series of sessions, generally for about 15 minutes each.
  • Minoxidil–  Minoxidil is an oral medication that can help to slow hair loss and in some cases, even help regrow hair. It does have a few side effects, but these are relatively mild and easy to manage with proper guidance from your doctor.

There is hope, with respect to frontal fibrosing alopecia. To begin with, there are already multiple successful treatments that exist, so you do not need to feel helpless in the face of this condition. The next step is to consult with a doctor who can help you figure out the best way for your body to combat both inflammation and future hair loss. Remember, your symptoms will be fully individualized, so it’s essential for you to work closely with your doctor. You may need both medications and other approaches, or one approach alone may fully silence the symptoms of this condition. Finding the right treatment may take some time—so be patient and select the long-term approach. The end result will be well worth it!

You may also find it helpful to know what symptoms to look out for, which can help ensure that you get the treatment you need as soon as possible. While it is difficult and time-consuming for doctors to come up with an effective treatment for this condition, there are some things that you can try at home to help combat your symptoms. One of the most important things you can do is keep your stress levels under control. Of course, in the end, everyone is different, so this information may not work for everyone, but don’t be afraid to explore all potential avenues.

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