Frontal fibrosing alopecia.

Department of Dermatology, New York University School of Medicine, USA.
Dermatology online journal 02/2005; 11(4):6.
Source: PubMed

ABSTRACT A 75-year-old woman presented with a 3-year history of progressive loss of her eyebrow hair and with frontal-parietal hairline recession. Multiple biopsy specimens supported a histopathologic diagnosis of lichen planopilaris. With these histolopathologic findings, and the patient's clinical presentation, a diagnosis of frontal fibrosing alopecia was made. Treatment to date with topical glucocorticoid preparations, intralesional triamcinolone injections, and tacrolimus ointment have been unsuccessful.

1 Bookmark
  • [Show abstract] [Hide abstract]
    ABSTRACT: Frontal fibrosing alopecia (FFA), is an acquired clinical entity characterized by a scarring, slowly progressive alopecia of the frontoparietal hairline. It is commonly accompanied by thinning or complete loss of eyebrows. Although there are only 117 cases reported, it is likely that FFA is more frequent than it has been thought as it is often misdiagnosed or not diagnosed at all. Epidemiologic data show that the disease, in the vast majority of cases, primarily affects women older than 60 years of age. The histology of FFA is indistinguishable from that of lichen planopilaris and Lassueur-Graham-Little-Piccardi syndrome, and the diagnosis depends mainly on the clinicopathologic correlation. Lymphocytic infiltration surrounding the upper portion of hair follicles confirms FFA. Treatment modalities are not efficacious. In cases where the disorder is rapidly progressive, short courses of oral prednisone or chloroquine may temporarily stabilize the disease; however, further progression after the withdrawal of steroids has been reported. Larger series are needed to assess more clinical, histological and epidemiologic data. There are many questions pertaining to the etiopathogenesis and treatment of FFA that remain to be answered.
    Expert Review of Dermatology 09/2008; 3(5):605-612. DOI:10.1586/17469872.3.5.605
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Frontal fibrosing alopecia (FFA) was first described in 1994 and is considered a variant of lichen planopilaris in a patterned distribution that primarily affects postmenopausal women. Cicatricial alopecia of the frontoparietal hairline is characteristic; the affected area appears as a shiny, band-like zone of incomplete hair loss with skin-coloured small hyperkeratotic papules. We describe a case of a premenopausal woman with this rare disease. To date there are very few reports of FFA in premenopausal women. The immunohistochemical investigation with lymphocytic markers (CD4, CD8, CD20, CD45RA, CD57) revealed CD8 positive lymphocytes penetrating the follicular epithelium. Direct immunofluorescence showed clumped deposition of IgM along the follicular basement membrane zone.
  • [Show abstract] [Hide abstract]
    ABSTRACT: Frontal fibrosing alopecia (FFA) is a primary lymphocytic cicatricial alopecia with characteristic clinical pattern of progressive frontotemporal hairline recession, perifollicular erythema and hyperkeratosis and symptoms of itch and burning, occurring mainly in post-menopausal women. FFA is considered a subtype of lichen planopilaris (LPP), based on their identical histopathology. Currently, no evidence-based treatment is available for FFA. Our aim was to determine the effectiveness of available treatment options for FFA, and to identify promising treatment options for future studies. For this, literature search was conducted to find all primary studies on the treatment of FFA and LPP. From the primary studies, data were subtracted and analysed. No randomized controlled trials were found, and one controlled trial. Treatment of 114 patients is described in the literature. They received 10 different regimes, of which oral 5-alpha-reductase inhibitors were provided most often, resulting in good clinical response in 45% of them. Hydroxychloroquine resulted in good clinical response in 30% of the 29 treated patients. Topical corticosteroid preparations are ineffective in FFA. The remaining treatments were all reported in less than 10 patients. For the treatment of LPP, topical corticosteroid preparations are the first line of treatment, followed by oral cyclosporine and systemic corticosteroids, although they are characterized by a high relapse rate. Summarizing, there is currently no effective treatment of FFA, the most effective being oral 5-alpha-reductase inhibitors that possibly affect the accompanying androgenetic alopecia. We argue that oral cyclosporine A might be a good candidate for future studies on the treatment of FFA.
    Journal of the European Academy of Dermatology and Venereology 03/2013; 27(12). DOI:10.1111/jdv.12139 · 2.69 Impact Factor