[Frontal fibrosing alopecia]

Within the group of cicatricial alopecias, Kossard first described frontal fibrosing alopecia (FFA) in 1994 as a variant of lichen planopilaris (LPP). This classification is based on the histopathological findings of FFA and LPP, which are identical and therefore not separable. The clinical picture of FFA, however, is very characteristic and marked by regionally distinct structures of the skin. Typically, postmenopausal women present with a band-shaped atrophy that is several centimeters wide located in the frontotemporal area. Adjacent to the hairline, perifollicular erythema and papules can be found. In the majority of patients there is a loss of the eyebrows. Circumscribed alopecia and perifollicular papules occur only rarely on the extremities or the trunk. Etiology and pathogenesis of FFA are unclear. Hormone-related involutionary phenomena of the follicle, genetic factors, disruption of lipid homeostasis, and in accordance with the lichen planus associated T‑cell cytotoxic autoimmune response are discussed. Treatment of FFA is difficult. Atrophy cannot be influenced by the currently available treatment options. With regard to the follicular inflammation, topical steroids and systemic hydroxychloroquine, antiandrogens, and tetracyclines are mainly used on a topical basis.