Frontal fibrosing alopecia is the frontotemporal
hairline recession and eyebrow loss in postmenopausal women that is associated with perifollicular erythema, especially along the hairline.
[Freedberg, et al. (2003). ''Fitzpatrick's Dermatology in General Medicine''. (6th ed.). McGraw-Hill. .] It is considered to be a clinical variant of
lichen planopilaris.
Presentation
There is loss of both
terminal and
vellus hairs that occurs in a bandlike pattern on the frontotemporal
scalp. It is a scarring alopecia that has been associated with facial papules, glabellar red dots, a loss of eyebrows, and prominent venous vasculature in the forehead.
Facial
hyperpigmentation may occur in dark-skinned patients if association with
lichen planus pigmentosus is present.
Associations
Frontal fibrosing alopecia has been most often reported in post-menopausal women with higher levels of affluence and a negative smoking history. Autoimmune disease is found in 30% of patients.
Pathogenesis
Although the pathogenesis of frontal fibrosing alopecia is poorly understood, autoimmune reaction and hormonal factors may play a role.
[Macdonald A, Clark C, Holmes S. Frontal fibrosing alopecia: a review of 60 cases. J Am Acad Dermatol. 2012;67(5):955-61.]
Diagnostic
Perifollicular erythema and scarring white patches are seen on dermoscopy. On scalp biopsy, lymphocytic and granulomatous
perifolliculitis
Perifolliculitis is the presence of inflammatory cells in the skin around the hair follicles. It is often found accompanying folliculitis, or inflammation of the hair follicle itself. It can have infectious
An infection is the invasion of ti ...
with eccentric atrophy of follicular epithelia and perifollicular fibrosis are visualized.
Differential diagnosis
Important diagnoses to consider include
female pattern hair loss (FPHL), chronic
telogen effluvium (CTE), and
alopecia areata (AA). FPHL is a non-scarring progressive miniaturization of the hair follicle with one of three different characteristic patterns. CTE is an idiopathic disease causing increased hair shedding and bi-temporal recession, usually in middle aged women. AA is an autoimmune attack of hair follicles that usually causes hair to fall out in small round patches.
Treatment
Improvement or stabilization of the condition has been reported with topical and intralesional
corticosteroid
Corticosteroids are a class of steroid hormones that are produced in the adrenal cortex of vertebrates, as well as the synthetic analogues of these hormones. Two main classes of corticosteroids, glucocorticoids and mineralocorticoids, are involv ...
s,
antibiotic
An antibiotic is a type of antimicrobial substance active against bacteria. It is the most important type of antibacterial agent for fighting bacterial infections, and antibiotic medications are widely used in the treatment and prevention of ...
s,
hydroxychloroquine, topical and oral
immunomodulators,
tacrolimus, and most recently,
5α-reductase inhibitor
5α-Reductases, also known as 3-oxo-5α-steroid 4-dehydrogenases, are enzymes involved in steroid metabolism. They participate in three metabolic pathways: bile acid biosynthesis, androgen and estrogen metabolism. There are three isozymes of ...
s. In one study, the use of
antiandrogens (finasteride or dutasteride) was associated with improvement in 47% and stabilization in 53% of patients
Recently, successful treatment of facial papules in patients with frontal fibrosing alopecia was described with oral
isotretinoin.
[Pirmez R, Duque-Estrada B, Barreto T, Quintella DC, Cuzzi T. Successful Treatment of Facial Papules in Frontal Fibrosing Alopecia with Oral Isotretinoin. Skin Appendage Disord 2017;3:111-113. doi=10.1159/000464334]
See also
*
Skin lesion
References
External links
{{Medicine, state=collapsed
Conditions of the skin appendages