Is disappearance of scaling a good sign in FFA?
Do I need treatment for my scarring alopecia or not?
I’ve selected this question below for this week’s question of the week. It allows us to review some concepts regarding how we monitor disease activity in FFA
Question
I have FFA and was diagnosed 4 months ago. I’m on topical steroids and steroid injections and have now started dutasteride. I notice my scaling is no longer present so I was a little reluctant to start dutasteride as I’m wondering if my disease is going quiet or dormant in some way.
Is reduction in scaling a good sign that means the disease is dormant?
Answer
Thanks for the terrific question.
It could but but that would be unusual with the information given so far. It takes about 18-24 months to confidently know FFA is quiet. If the amount of hair on the scalp, eyebrows, eyelashes and body is 100% the same between two time points 24 months apart then it's likely dormant with 96 %-98 % certainty. But keep in mind there are two types of dormant - medication induced dormant and true disease burnt out dormant. Disappearance of scaling is a good sign but not very sensitive. Scaling can disappear with frequent washing and application of highly hydrating creams, ointments, gels and lotions. The key is the progression of the disease via photos. Nothing speaks to the dormancy of the disease better than photos.
Here is a helpful guide for stable vs inactive vs burnt out LPP. It applies to FFA too. You can read the full article by just clicking on the image.
The 14 Key Questions to Answer to Determine if Scarring Alopecia is Burnt Out
In our clinic, the likelihood of a scarring alopecia being actually “burnt out”depends on patient answers to 14 questions. You can review the full article here to determine how to better evaluate how inactive a scarring alopecia truly is based on the answers to these questions.
Group A Question
1. Did you use any topical, injection or oral medications over the last 2 years specifically for treatment of your scarring alopecia?
Group B Questions
2. When you compare a good series of 10-12 photos taken 2 years ago to another good series of 10-12 photos taken today, do you agree that some images show that you have lost more hair compared to 2 years ago?
3. Do you feel there are less hair follicles on the scalp today compared to 2 years ago?
4. Do you feel your eyebrow density is currently less than what it was 2 years ago?
5. Do you feel your eyelash density is currently less than what it was 2 years ago?
6. Did you need any hair loss medications in the last 2 years to keep your scalp feeling calm or to keep it from flaring?
Group C Questions
7. Do you experience periods of time in the last 2 years where you had some degree of scalp burning?
8. Did you experience periods of time in the last 2 years where you had any tender areas on the scalp (like a bruise)?
9. Did you experience periods of time in the last 2 years where you had pimples or bumps forming on the scalp?
Group D Questions
10. Did you experience periods of time in the last 2 years where you had prolonged scalp itching (more than just an occasional itch every few month)?
11. Did you experience periods of time in the last 2 years where your scalp gets redder than you feel is normal?
12. Do you feel your scalp is currently more red than what you would say is normal?
Group E Questions
13. Do you feel your daily hair shedding is currently above what you feel is normal?
14. Did you experience periods of time in the last 2 years where you had increased hair shedding above what you feel is normal?