What is frontal fibrosing alopecia?
Along the frontal scalp hair margin, frontal fibrosing alopecia is a patterned form of scarring hair loss. In 1994 it was first described in a group of Australian women.
Who gets frontal fibrosing alopecia?
Although a Caucasian post-menopausal woman over the age of 50 younger women, men, and children, and all ethnic groups including Asians, Hispanics, and those of African descent can be affected the typical patient with frontal fibrosing alopecia was described.
To be increasing worldwide the incidence is reported. In patients with hypothyroidism, contact allergy to fragrances, regular sunscreen use, and autoimmune diseases frontal fibrosing alopecia is frequently reported.
What is the cause of frontal fibrosing alopecia?
In the pathogenesis of frontal fibrosing alopecia Genetic, hormonal, autoimmune, inflammatory, and environmental factors have postulated roles. With frontal fibrosing alopecia pairs of monozygotic twins and in some cases suggest a genetic tendency positive family histories reported. By the predominance of post-menopausal patients, an androgen-dependent aetiology has been suggested.
Due to the resemblance on histology frontal fibrosing alopecia has been considered a variant of lichen planopilaris and with various forms of lichen planus association, but that raise doubts there are also many differences.
What are the clinical features of frontal fibrosing alopecia?
As a uniform linear band of hair loss along with the front frontal fibrosing alopecia usually presents, resulting in a receding frontal hairline and side of the scalp hair margin.
Allowing assessment of the extent of the recession, seen on the forehead the skin in the affected area lacks the sun damage. Without visible hair follicle openings, it looks pale, shiny, or mildly scarred. Around involved hairs during the active phase, redness and scale are visible.
To the frontal hairline hair loss in frontal fibrosing alopecia is usually not restricted. The scalp changes eyebrow thinning or loss often precedes. On all parts of the body hair loss can affect, and total loss in limbs is common.
What are the dermoscopy features of frontal fibrosing alopecia?
Dermoscopy reveals absent follicles, tubular perifollicular scale, perifollicular erythema and white dots. In skin that tans easily, perifollicular pigmentation.
How do clinical features differ in various types of skin?
From Caucasian women, women of African descent with frontal fibrosing alopecia present differently. Often in their early 40s before menopause, typically they present at a younger age. Scale, itch and redness are less obvious. Lichen planus pigments are usually preceded the hair loss and are commonly associated. Along with the frontal hair margin, speckled pigmentation of hair follicles is seen on dermoscopy. Due to associated traction alopecia, frontal fibrosing alopecia may be overlooked.
How is the diagnosis of frontal fibrosing alopecia made?
Features of clinical frontal fibrosing alopecia are characteristic:
To exclude other forms of scarring alopecia skin biopsy may be required. The histopathological features are identical to those of lichen planopilaris.
A lichenoid pattern of inflammation, sebaceous gland hyperplasia and fibrosing alopecia, a biopsy of skin papules may also show.
- Scarring loss of eyebrows.
- In the absence of follicular keratotic papules on the body scarring hair loss of the frontal or frontotemporal.
- Around hair follicles, redness and scale, or solitary lonely hairs are best seen on dermoscopy.
- On skin biopsy characteristic histology.
- Involving other body sites, similar clinical signs.
- At sites of involvement itch or pain preceding or concurrently.