Do I have Frontal Fibrosing Alopecia (FFA)? A Look at the Criteria

Proposed Criteria Help Guide Diagnosis of FFA

“Do you think I have frontal fibrosing alopecia (FFA)?” 10 years ago it would be rare for a patient to spontaneously ask this question. Now it’s common. Paralleling the rise in the number of cases worldwide of FFA being diagnosed is the increase in awareness of this condition. FFA is still rather rare with anywhere from 1:5000 to 1:10000 people affected (my estimate) depending on the country.

Diagnosis of FFA is more than simply “I think my hairline is changing.” After all, the “I think my hairline is changing” patient could have androgenetic alopecia, traction alopecia, alopecia areata, trichotillomania, lupus, or telogen effluvium ... or 20 other conditions too.

Criteria for FFA have been suggested in recent times. The 2 major criteria focus on the classic hairline changes and classic eyebrow changes. The minor ones pertain to trichoscopy, histology and two other clincial features - the loss on other areas of body and the so called facial papules. Diagnosis requires 2 major criteria or 1 major and 2 minor.

Does this patient have FFA or not?

The patient in this photo above does not have FFA. She has frontal hairline loss but it is not scarring. She has miniatured and vellus (small pale hairs) that are typical of androgenetic alopecia but would be unusual for FFA. She has eyebrow loss from over shaping and tweezing but not from FFA. Her dermoscopy does not favor FFA and she does not have hair loss on other sites that is in keeping with FFA not does she have facial papules.