Frontal fibrosing alopecia (Frontal fibrosing alopecia (FFA))

Frontal fibrosing alopecia (FFA) is a scarring alopecia first described in 1994 and now diagnosed with increasing frequency. It primarily affects postmenopausal women, though premenopausal women and a small number of men are also affected.

The clinical picture is recession of the frontal hairline, often symmetric, with a band of pale, smooth, scarred-looking skin behind the receding line. Eyebrow loss is common (around 50 to 80% of patients) and may precede the hairline change. Loss of body hair, axillary hair, or limb hair can also occur.

FFA is considered a clinical variant of lichen planopilaris (LPP), with similar histology and overlapping treatment approaches.

Treatment aims to halt progression rather than regrow hair. Standard options include topical and intralesional corticosteroids, hydroxychloroquine, oral 5α-reductase inhibitors (finasteride, dutasteride), and immunomodulatory agents in resistant cases. Early diagnosis matters; the lost frontal area cannot be restored without transplantation, and transplantation into active disease often fails.