Frontal Fibrosing Alopecia-Cicatratial Alopecia

       

Definition: 

Frontal Fibrosing Alopecia (FFA) is a special form of Lichen Planopilaris(LPP) that is characterised primarily by band-like cicatricial alopecia in slow progressive way with scar formation on the frontoparietal  region of the scalp .

Fig-Frontal Fibrosing Alopecia

Description:

1) In some cases, the eyebrows, eye lashes and/or other parts of the body may be involved, as well.

2) FFA predominantly affects postmenopausal women (20%) & 1-2% men also.

3) Many cases of FFA reported after surgery like hair transplant & facial lifting.

History:

 It was first described by Kossarden in 1994 in a group of Australian women.

Diagnosis: 

FFA can be easily diagnosed by clinical features with characteristics sign & symptoms and followings are the sign & symptoms of FFA.

Clinical Features:

Sign:-

1) Follicular orifices are lost in the affected area especially in frontal receding area of scalp.

2) Skin of affected are atrophied & looks normal but it is pale and shiny.

Fig-Signs of FFA

3) Perifollicular Erythema is present  on scalp margin.

4) Eyebrows are often thinned or may even be absent in half of the people who are affected.

5) Less commonly eye lashes involved.

6) Depression of frontal and temporal veins.

7) “Lonely hair sign” is like an illusion to have one hair in an area of none.

Symptoms:-

1) Typical whitish scarred strip of hair loss at hair line, red in colour & inflamed.

2) Mostly found in female after menopause or may be before the menopause

3) In some cases Female also have Female Pattern Thinning(FPT) with FFA.

4) Pruritus is rarely noticed.

5) Alopecia sometime observed in axillary(underarms) and pubic area also.

Differential Diagnosis:

We may get confuse between FFA and Androgenetic Alopecia, Spot Baldness,  Chronic Lupus Erythematous, Traction Alopecia etc so we should know the differential diagnosis among them.

Androgenetic Alopecia(AGA):-

It mostly affects the anterior hair line of the scalp.There is no any scar formation or perifollicular erythema. Miniaturisation of follicles are seen when biopsy done and the that is the diagnostic feature of AGA.

Alopecia Areata(AA):-

Sudden onset of FFA affecting eyebrows & occiput area may get you into the confusion with Alopecia Areata/Spot Baldness but AA has a exclamation mark, black dots and yellow dots and FFA does not have any of these so it can make clear difference between them. And detail explanation about Spot Baldness or Alopecia Areata, I have written in my earlier post.

Chronic Lupus Erythematosus:-

It presents as a plaque like scar formation in frontal area but there is pigmentation, diffuse hyperkeratosis & erythema which are not present in FFA.

Traction Alopecia:-

It is most common in women and it also covers the anterior frontal hairs but here we should look for the sliding ducts in the traction zone or area of hair loss because that is the one of the diagnostic feature of Traction Alopecia

Etiology:

1) The exact cause of FFA is not known yet but it may be an Auto-Immune Disease in which the affected person immune system by mistakenly attacks his hair follicles. And some scientists believe that there may be involvement of hormones also because it mostly affects the female in their menopausal age.

2) No any genetic background in FFA has been found till now in any research but increasing numbers of FFA in families now suggesting a genetic factor. Environmental factor, drugs, sun exposure & viral infection, could have a triggering effect in genetically predisposed patients.

Pathogenesis:

It is all about how the disease develops. Unlike hereditary scientists believe that FFA is caused by immune system attacking the hair follicles with  inflammation & ultimately there is formation of fibrosis & then hair does not grow back from that area and that’s why called Fibrosing Alopecia. Skin in the affected area may look normal but scarred one.

Histological Findings:

1) Reduction in number of hair follicles with high number of vellous & intermediate follicles.



              Fig-Demographic findings

2) Lymphocytic inflammatory infiltrate & perifollicular fibrosis are seen.

               Fig-Histological Findings

Prognosis:

Prognosis of FFA is very slow in nature & it varies for people but after few yrs it does come to an standstill position.

But in some patients hair regrowth also reported but it depends on the condition of the case.

Treatment:

As I always say, there are many modes of treatment in our great country India for any kind of disease.

But mostly people prefer to take treatment from Old School of Medicine(Allopathy)as their first choice and when some percentage of them do not get any benefit or cure then they do take a move towards the other option available in medical field. Yes, here we are talking about the world’s 2^nd largest practicing medicine called Homoeopathy.

But it does not take Allopathy as first choice of your treatment, here I only try to give the people thinking as I observe in my day to day practice.

Homoeopathy has a great scale for treating every kind of diseases for last 200 years.

Old School of Medicine:-

There is no any standard & perfect treatment for Frontal Fibrosing Alopecia as of now in medical line of field but its causation is associated with inflammation of hair follicles as we discussed in its pathogenesis, so we do its treatment by giving some Anti-Inflammatory medications like corticosteroid(sometime in combination of Minoxidil 2-5%), hydroxychloroquine to reduce inflammation and 

suppress body immune system. So, there is no effective treatment.

Oral steroid and Intralesional steroidal injections can also be given.

Finasteride in some case given to block the male hormone by blocking 5-alpha reductase to stop further hair loss but it is not specific for FFA. It is given to those female who has FPT also.

TNF-alpha(Tumor Negrosis Factor alpha) has been reported effective in few patients.

Homoeopathy:-

As I told you, Homoeopathy has a great scale of treating every kind of diseases but it does not mean that it gives life to the dead.

Yes, you heard right.

FFA is case of cicatricial alopecia with scar formation so no any school of medicine could give assurance for hair regrowth, only the condition can be subsided but also I would like to recommend Homoeopathy for it  because Allopathy you have to face certain bad effects and which is not there in Homoeopathy. 

Homoeopathy does not have a specific drug for any kind of disease so if you have any kind of such hair problem consult a Trichologist first. For the same you can also reach us in HairTalk clinic. For appointment give your comments in comment box.

So, this is all about the Frontal Fibrosing Alopecia as per my best of best knowledge but anything more you want to know, you can give our question in comment.

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