Frontal Fibrosing Alopecia

Frontal fibrosing alopecia (FFA) is a new entity of scarring hair loss. This is not meant to be an exhaustive treatise on FFA but is meant to highlight a disease that the etiology is unclear. FFA was first described by Kossard in 1997 in a report on several postmenopausal Caucasian women. Although most patients are elderly women, an identical pattern of hair loss has been observed in premenopausal women, including African Americans as well as Caucasians. Cases of family groupings that share HLA-D have been observed, but it is not a consistent finding. Initially FFA was considered to be a variant of lichen planopilaris since the histologic findings are similar. There are enough differences in the pathology and non-responsiveness to treatments to consider it a separate entity. This chapter is a brief overview of FFA that may be seen more often in the dermatology practice setting and practice of hair restoration.