Frontal Fibrosing Alopecia (FFA) is a primary inflammatory condition where lymphocytes (a type of white blood cells) target and destroy fine and vellus hairs on the scalp, face, and less commonly, the body.
FFA is common amongst postmenopausal women with early symptoms presenting around 50-60 years of age. Initially this condition was only seen in Caucasian women but over the past few years cases have emerged amongst African American and Hispanic women.
FFA presents as a band of hairline recession along the scalp. Itching may or may not be present. The skin on the forehead and temples is thinner and blood vessels appear prominent in fairer skin. With the use of a dermatoscope, one can appreciate fine bumps around hair follicles. In areas of long-term or permanent hair loss, the follicles scar over and the follicular openings cannot be visualized.
Women suffering from FFA also notice thinning or complete loss of facial and body hair including eyebrows, sideburns, eyelashes, arms, legs, and underarm hair. The skin surrounding eyebrow hairs may also be affected and can appear red and inflamed.
The cause of FFA is still unknown. FFA is responsive to topical anti-inflammatories and medications that block androgens prompting speculation that there may be a hormonal influence to this condition. The inflammation destroys the stem cells located near the sebaceous glands (article on anatomy of hair follicle) which are needed to regenerate hair. Early diagnosis and treatment is important to halt the progression and if caught early enough, can salvage follicles not yet destroyed by the lymphocytes.
FFA requires a detailed history from the patient, a thorough exam, and if warranted, a biopsy. The work up for FFA is necessary because other hair loss conditions such as traction alopecia and lichen planopilaris can look similar to FFA but require different treatments. It is also important to know that more than one hair disorder can present in the same individual.
Below are photos of individuals with FFA involving the scalp and/or eyebrows.