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Frontal Fibrosing Alopecia: An Update on Pathogenesis, Diagnosis, and Treatment

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Abstract

Frontal fibrosing alopecia (FFA), first described by Kossard in the early 1990s, is a form of primary lymphocytic cicatricial alopecia characterized by selective involvement of the frontotemporal hairline and eyebrows. Since the original description, an increasing number of cases have been reported worldwide and the clinical aspects of the disease have been better characterized. However, the pathogenesis is still unknown and several hypotheses have been made about possible triggering factors, including hormones, neurogenic inflammation, smoking, UV filters, and ingredients in leave-on facial products. A genetic basis has also been hypothesized as the disease can occur in siblings and members of the same family. Besides its pathogenesis, research is also focused on treatment; FFA is a chronic condition and at present there is no validated or approved treatment for this disorder. Commonly prescribed topical treatments include corticosteroids, minoxidil, and calcineurin inhibitors. Systemic treatments include 5α-reductase inhibitors, hydroxychloroquine, and retinoids. Intralesional triamcinolone acetonide is also utilized, especially for the eyebrows. Other possible treatments include pioglitazone, naltrexone, tofacitinib, and lasers.

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Authors and Affiliations

  1. Private Dermatology Practice, Viale Stazione 16, 6500, Bellinzona, Switzerland

    Matilde Iorizzo

  2. Fredric Brandt Endowed Professor of Dermatology, Miller School of Medicine, University of Miami, Miami, FL, USA

    Antonella Tosti

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  1. Matilde Iorizzo
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  2. Antonella Tosti
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Correspondence to Matilde Iorizzo.

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No sources of funding were received for this review.

Conflict of interest

M.I. has nothing to declare. A.T. is a consultant for P&G, Pfizer, DS Laboratories, Monat, and Thirthy Madison, and is a principal investigator for Incyte, Aclaris, Lilly, and Nutrafol.

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Iorizzo, M., Tosti, A. Frontal Fibrosing Alopecia: An Update on Pathogenesis, Diagnosis, and Treatment. Am J Clin Dermatol 20, 379–390 (2019). https://doi.org/10.1007/s40257-019-00424-y

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