Comparing Ophiasis Alopecia Areata to Occipital Frontal Fibrosing Alopecia

How does ophiasis alopecia areata differ from frontal fibroging alopecia that affects the back of the scalp?

The ‘occipital scalp’ refers to the region of the scalp at the back - just above the neck. The occipital scalp There are many hair loss conditions that can affect the occipital scalp including alopecia areata (ophiasis form), frontal fibrosing alopecia, traction alopecia, trichotillomania, dissecting cellulitis, psorasis, seborrheic dermatitis, hair shaft disorders (monilethrix), acne keloidalis and others.

FFA vs Ophiasis: Key Skills for the Practitioner:

It is important for the hair loss practitioner to be able to differentiate between the various conditions that can affect the back of the scalp. Today, we’ll take a look at key differences between ophiasis alopecia areata and frontal fibrosing alopecia.

Frontal Fibrosing Alopecia affecting the occipital scalp. About 25 % of patients with FFA have occipital loss.

Alopecia areata ophiasis is a form of alopecia areata that affects the back of the scalp as well as the area behind the ears.

Comparing AA and FFA

The following chart compares FFA and alopecia areata ophiasis. Patients with FFA are typically a bit older and more likeey to be female. The sites of involvement are similar overall although alopecia areata ophiasis tends to wrap further around behind the ears than does FFA. Symptoms are slightly greater in FFA although many patients with FFA and alopecia areata have no symptoms. Shedding tends to be higher in alopecia areata and so does the overall speed of hair loss.

Trichoscopy findings are different in the two conditions and this can help different the two conditions in many cases. Trichoscopy of alopecia areata ophiasis shows exclamation mark hairs, black dots, yellow dots and vellus hairs. Trichoscopy of FFA showed redness and scale around hairs and a generally destruction of tiny vellus hairs. The pathological findings also differ - with FFA showing inflammation higher up with loss of sebaceous glands and alopecia areata showing inflammation lower down with no loss of sebaceous glands. Treatments are somewhat similar given that both are lymphocytic inflammatory conditions. Differences in treatment are shown in the chart.