What is frontal fibrosing alopecia?
Frontal fibrosing alopecia (FFA) is a variant of Lichen Plano-Pilaris an example of primary alopecia, meaning the hair follicle itself is a target for inflammation. The inflammation destroys the hair follicle and leaves behind scar tissue, meaning the hair is unable to regrow, even with hair loss treatments.
The condition mostly affects the scalp, rarely it may affect others areas of the body too, resulting in hair loss.
It most typically affects the frontal region of the hairline, the sides and hairline above the ear lobes and in our experience seen in all patients across all ethnicities, African, Asian and Caucasian. In the Caucasian group it affects more so post menopausal women. This does not exempt men.
What causes FFA?
There’s no precise answer to this question, as yet. We know that it is not hereditary. We have observed inflammation of the hair follicle. Then we have also noted the response of lymphocytes, cells that form part of the body’s immune response, attacking the hair follicles.
The correlation of the condition with postmenopausal people suggests there may be a link with hormones, although this has not been established with certainty. The correlation in African women with traction hairstyling suggests a strong link with trauma to hair follicle as a precipitating and worsening factor in this ethnic group. The reason for it to affect the frontal hairline is also unknown. It is also thought to be affected by genetics, an overactive immune system, or hormonal changes.
The symptoms of FFA
Similar to other forms of scarring alopecia, FFA may show no symptoms. It might also present in itchy, tight-feeling scalp that may also be painful. The scalp becomes smooth and shiny with or without loss of follicular markings. Patients with FFA also experience loss of the lateral third of their eyebrows, Pigmentation or grey-blue-black pigmentation of the face and neck. They may also note thickening of the skin along the temporals.
The diagnosis of FFA
Getting a diagnosis involves taking a skin biopsy. Dr. Khoza will take a sample of skin and examine it under a microscope. The biopsy will require you to have a local anesthetic by injection and a small scar may remain after the procedure.
FFA hair loss treatments and cures
This condition may continue, or it may resolve itself. Unfortunately, FFA remains a dermatology hair emergency as any scarring that has occurred cannot be reversed and hair will not regrow in those areas.
There are a number of hair loss treatments available with varying efficacy. Certain hair loss treatments deliver incredible results to some people, and others may experience no effect.
Hair loss treatments available for FFA
Topical corticosteroids – These are effective but should be used in conjunction with other hair loss treatments in order to completely halt the receding of the hairline. The treatment is usually a gel, lotion, or cream applied locally.
Topical Tacrolimus – An ointment that is applied locally to soothe the inflammation and calm the overactive immune response.
Intralesional steroids – These steroids are injected into the hairline. These hair loss treatments will need more than one application, usually. It aims to slow the progression of the hair loss if not stop it all together while soothing the inflammation.
Antibiotics – In this case, they’re not used to fight bacteria but rather for their anti-inflammatory properties. They soothe the redness and itching of the scalp.
Hydroxychloroquine – In some people, this treatment may cause the condition to become inactive, halting any further hair loss. It does come with some risk factors and will need to be repeated over a course of 4-6 months before Dr. Khoza can determine whether or not it will be effective. The results vary on a case-by-case basis.
Immunomodulatory drugs – By calming the inflammation of the follicles, the immune system is often relaxed. When the lymphocytes stop attacking the follicles, the condition eases. These hair loss treatments also vary in efficacy from person to person.
Antiandrogen hair loss treatments – This treatment is effective for people where the possibility of hormonal influence is present. It works by raising the levels of testosterone (male hormone) around the hair follicles to reduce inflammation. This tactic is often used to treat female pattern hair loss and where the two conditions may overlap, this angle can be effective.
Hair care at home
This condition can have an effect on every area of life, most markedly, self-confidence. It is important to maintain a positive support structure, be it friends, family, or counseling sessions.
A wig may help too. There are companies specialising in wigs that look natural. It is important to remember not to opt for any styles or treatments that place tension on the hair, this can result in further hair loss (traction alopecia).
There are cosmetic treatments to hide hair loss of the eyebrows and lashes. Microblading is a popular method, involving hyper-realistic hairs being tattooed onto the skin to form eyebrows.
The effects of hair loss
Hair loss can be a very distressing experience, you may feel powerless and frustrated. It is important to ensure you have a good sense of moral and emotional support, and finding a new source of confidence through hobbies or interests may help, although it can be challenging to try new things. It is important to remember your dermatologist is here to support you through this journey and find the best way to combat the symptoms. The goal is to give you the greatest chance of maintaining full and lustrous hair growth.
Scalp disorders and hair loss treatments with Dr. Nokubonga Khoza
Our hair loss and scalp disorders consultation take about 20-30 minutes. Only conditions relating to the scalp will be discussed during this session. All patients are expected to fill out a pre-assessment form on arrival to the practice. There are many causes of hair loss and scalp disorders and surprisingly they can look similar. Dr. Khoza’s primary goal is to provide the highest level of care when it comes to skin and scalp disorders. Our hair consults focus is on proper diagnosis, non-surgical management, counselling and preventing further disease progression.
During the consultation, Dr. Khoza will review the patients past medical history, medication, hair grooming practices, and styling. She will examine the scalp with the use of dermoscopy and take relevant pictures. Should there be a need; Dr. Khoza may order blood tests, take hair samples and perform a scalp biopsy. Dr. Khoza performs the following in-office procedures for hair loss; Platelet rich plasma, micro-needling and intralesional injections.
Please note all procedures are scheduled for a separate appointment and are not performed on the same day as the initial consultation.
Estimated time for procedures:
- Scalp biopsy – 20 minutes
- Intralesional scalp injections – 10 minutes
- Micro-needling – 30 minutes
- Platelet Rich Plasma – 1 hour
How to prepare for your consultation with Dr. Khoza
- Take careful note of your symptoms. It is important to give Dr. Khoza an accurate description of what you have been experiencing. Has the hair been falling out gradually? Has it been only in certain patches, or has it been a constant and ongoing “loss” from all over the scalp?
- Think of any changes in your life that may coincide with the hair loss. Have you been taking a new medication, or have you stopped using a medication? Have you changed your level of physical activity? Have you gone through any major stresses, changed your diet, started or stopped taking any vitamins, or used a new hair or skin product, like shampoo?
- Be prepared for questions. Dr. Khoza will also want to know if hair loss runs in your family, and if so, at what age did your relatives experience hair loss for the first time?
- Dr. Khoza will examine your scalp during the consultation. Sebum, or oil, can sometimes play an important role in hair loss, so it may be advised to avoid washing your hair for a day or two prior to the appointment.
- Bring a list of medications used in the last two years.
- Bring your latest bloods if you have done any in the last six months.
- It always helps to bring all current hair and scalp products.
- Bring old photos up to 5 years prior if possible.
- Keep a positive outlook.
Improve the health of your scalp and hair with a comprehensive hair loss treatment plan designed for you. Contact Dr. Khoza and book your consult.