Frontal fibrosing alopecia
Frontal fibrosing alopecia is characterized by the recession of the hairline that increases the size of the forehead. It is a type of permanent alopecia whose treatment serves to slow its progression.
Symptoms and Causes
Frontal fibrosing alopecia is a type of scarring alopecia in which inflammation occurs that causes permanent hair loss. It develops progressively in the frontal region of the scalp and the eyebrows.
The characteristic pattern of frontal fibrosing alopecia is the recession of the hairline in a headband shape (linear pattern). Even so, sometimes it can manifest in a diffuse way, with dispersed hair loss in a zigzag pattern and decrease in hair density in the rest of the scalp.
Hair loss due to frontal fibrosing alopecia is irreversible, but with the appropriate treatment its progression can be slowed and the remaining hair preserved.
Symptoms
The characteristic symptoms of frontal fibrosing alopecia are:
- Recession of the scalp hairline, that is, the hair grows further and further back.
- Larger forehead.
- Loss of the eyebrows. This sign usually occurs much earlier than hair loss, even years before, beginning with the outer loss of the eyebrows.
- Loss of the sideburns.
- Lesions with an acne-like appearance.
- Redness of the cheeks, nose or glabella.
- Lesions on the temples that form a kind of relief.
Causes
Frontal fibrosing alopecia is the consequence of an inflammatory process that destroys the hair follicles whose causes are still not clearly known.
Risk factors
Studies indicate that the factors that increase the risk of frontal fibrosing alopecia are:
- Hormonal factors: it is more frequent in women in peri- or postmenopause or with pharmacological treatment of hormonal action.
- Genetic factors: several cases are often detected in the same family, especially in mothers and daughters, therefore it is believed that there is a genetic component.
- Autoimmune factors: the coexistence of this type of alopecia and other autoimmune diseases, such as hypothyroidism, contributes to suspecting.
- Environmental factors: the increase in diagnoses of frontal fibrosing alopecia in recent years suggests that there may be an environmental component, although it is still early to know the results of the studies.
Frontal fibrosing alopecia is more frequent in women, probably because it is a disease with a high hormonal component, but it can also affect men.
Complications
Hair loss in frontal fibrosing alopecia is permanent; if not treated in time, it could progress more than expected, although the disease itself usually slows its progression after the first notable shedding.
The most relevant consequences of this disease are psychological, as they can cause loss of self-esteem, distress, social isolation or depression.
Prevention
Frontal fibrosing alopecia cannot be prevented, as it is believed to have an autoimmune or genetic origin. As the results of studies on environmental factors influencing hair loss progress, it is possible that some preventive measures may be established, but it is still early to know.
What doctor treats frontal fibrosing alopecia?
Frontal fibrosing alopecia is treated within the specialty of Medical-surgical dermatology and Venereology.
Diagnosis
The diagnosis of frontal fibrosing alopecia includes the following protocol:
- Medical history: detailed study of the patient’s medical and family history, as well as their lifestyle and the symptoms they have perceived.
- Observation of the scalp to assess the hairline and the condition of the skin.
- Trichoscopy: a magnification camera is used, which is gently moved over the scalp, to obtain a better view of the condition of the hair follicles and the hair. In addition to confirming the diagnosis, it can be used to rule out other conditions. It may be performed periodically to assess the evolution of the patient after starting treatment.
Treatment
The treatment of frontal fibrosing alopecia is chronic, as it focuses on slowing the evolution of the disease and reducing inflammation. The most effective approaches are:
- Topical medication: gels, creams or shampoos with anti-inflammatory and hormone-modulating effect.
- Oral medication: depending on the characteristics of the patient, drug therapy in tablets may be chosen, with the same objectives as the previous ones.
- Hair mesotherapy: these are usually microinjections of corticosteroids in the scalp to slow inflammation and hair loss.
