Comment on Current Investigations into Frontal Fibrosing Alopecia

ABSTRACT

Frontal fibrosing alopecia (FFA) represents a patterned scarring alopecia. Initially considered uncommon, its frequency has increased since its original report in 1994. While its etiology has remained obscure, attracting the attention of researchers and giving rise to speculations on its etiopathogenesis, particularly hormonal and environmental factors. In our opinion, FFA is among the currently most misunderstood trichological conditions, with speculations as to its origins so far having been rather confusing than clarifying. Specifically, FFA may have existed before 1994; the pattern of clinical disease presentation may be more specific for the condition than the underlying pathology, either lichen planopilaris, discoid lupus erythematosus, or folliculitis decalvans; so far, questionnaire-based studies in patients with FFA on the use of sunscreens and cosmetics have not been conclusive; and extension well beyond the frontal and temporal hairline to involve sexual hormones-independent areas, such as the occipital hairline, facial vellus hair, and peripheral body hair, in men specifically anterolateral leg-like alopecia, neither supports a role of sexual hormones or estrogen-like endocrine-disrupting chemicals for pathogenesis, nor a role for antiandrogens and 5alpha-reductase inhibitors for the treatment of FFA. “Failure is in a sense the highway to success, as each discovery of what is false leads us to seek earnestly after what is true” (John Keats).