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  • Frontal fibrosing alopecia (FFA) is a chronic form of primary lymphocytic cicatricial alopecia characteristically involving the frontotemporal hairline and eyebrows.

  • There are three clinical subtypes of FFA: linear, diffuse, and pseudo-fringe.

  • The disease is becoming more and more common in most countries.

  • Pathogenesis and definitive causes of FFA are still unknown.


  • Localization of hair loss, loss of eyebrows, and presence of facial lesions suggest diagnosis.

  • Severe cases include loss of eyelashes and body hair.


  • Currently, there is no approved, standardized treatment for FFA.

  • Topical treatments include corticosteroids, minoxidil, calcineurin inhibitors, and lasers.

  • Systemic treatments include 5α-reductase inhibitors, hydroxychloroquine, retinoids, intralesional and systemic steroids, naltrexone, tofacitinib, and pioglitazone.


  • FFA and lichen planopilaris have common pathological features.

  • Clinical characteristics of FFA include:

    1. Mainly affects postmenopausal women.

    2. Receding hairline and loss of eyebrows.

    3. Facial lesions including papules, prominent veins, and lichen pigmentosus.


  • Avoid topical steroids and be cautious with intralesional steroids as they can worsen skin atrophy

  • Cosmetic ingredients can be a possible culprit


  • Trichoscopy is a clue for diagnosis, showing loss of vellus and intermediate hair along the hairline.

  • Pathological confirmation is usually not necessary.

  • In men, localized loss of sideburns and beard may indicate FFA.

  • Androgenetic alopecia and lichen plano-pilaris may be associated findings.

  • Progression is usually slow.


  • Although not established cosmetic and sunscreen ingredients, can play a role in progression and should be avoided along the hairline.


Frontal fibrosing alopecia (FFA) is a chronic form of primary lymphocytic cicatricial alopecia characteristically recession of the frontotemporal hairline and partial/total loss of the eyebrows (Figs. 32.1 and 32.2).1 As of late, there has been an increasing number of cases worldwide.1


FFA with loss of eyebrows.

It can be divided into three subtypes: linear, diffuse, and pseudo-fringe. The pattern of the cicatricial alopecia is band-like, with erythema and papules around the follicles along the hairline.2,3 Loss of hair in the limbs is also common, whereas pubic, and axillary hair are usually preserved.2 FFA is a variety of lichen planopilaris.2 The etiology of FFA is still unknown.


FFA is most commonly seen in postmenopausal women in their 60s.4,5 It is most frequently recorded in Caucasian women.6 Its incidence is increasing in the United States, Europe, and Japan,2 The prevalence in Black women may be an underestimation due to its co-presentation with traction alopecia.6 However, a small but increasing amount of men and premenopausal women are afflicted ...

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