Frontal fibrosing alopecia

Frontal fibrosing alopecia has been described only recently and is quite uncommon. Its name reflects 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 hair loss on the front and sides of the scalp. The skin in the affected area usually looks normal but may be pale or mildly scarred. There may be mild redness around the hair follicles at the margins.

Fibrosing alopecia

What is the cause?

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.

Frontal fibrosing alopecia may be a variant of lichen planopilaris, although this is disputed by some researchers. Lichen planopilaris results in bald patches on the scalp, and is associated with the more common skin condition lichen planus.

Investigations

A skin biopsy examination in the laboratory helps in making the diagnosis. The newly affected hair follicles are surrounded by a particular lichenoid pattern of inflammation associated with scarring.

Course and prognosis

Usually frontal fibrosing alopecia is slowly progressive. In a few patients it stabilises after a few years.

Treatment

There is no effective treatment available as yet. A short course of oral steroids or antimalarial tablets may benefit patients who have a rapid onset of hair loss.