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Frontal fibrosing alopecia

Frontal fibrosing alopecia (FFA) is a condition described by Steven Kossard in 1994. The prevalence of this condition is difficult to assess. Many authors consider FFA to be a subtype of LPP (lichen planopilaris). Scarring is a result of the lymphocytic inflammation, which leads to the permanent damage of hair follicles.

This condition most often affects post-menopausal women. In patients with the FFA, the percentage of pre-menopausal women does not exceed approximately 8%, while the percentage of men amounts to 2%. The main symptom is a slow gradual recession of the frontal and temporal hairlines. Rarely may the same process be observed in the parietal area. A frequent accompanying symptom is the thinning of eyebrows (especially the lateral parts) and hair in other body areas (armpits, groins and, less frequently, limbs). Sometimes, isolated hair dispersed on previously-hairy skin may be observed. Within the newly formed hairline, no vellus hair is observed, and sometimes skin erythema is visible. In a subset of FFA patients, small reddish papules may form on the face, sometimes considered to be rough skin.

Course of disease
The beginning of the condition is often difficult to note by a patient, and only a significant recession of the hairline is a reason to seek dermatological advice. The condition is slowly progressive; the rate of hairline recession varies from 0.3 to 1.7 mm per month. The thinning of hair within the eyebrows starts from the sides and progresses towards the middle, often leading to complete loss of eyebrows. Frontal fibrosing alopecia is irreversible.

The diagnosis is determined based on the clinical picture and trichoscopy.

The treatment is difficult, and retinoids are often used to obtain stabilization of the pathological condition.