Please login or create an account. If you do not have access to this content, you will be shown a 30 second preview and licensing options.
- Presentation
Atypical Clinical Presentations and Red Flags of Frontal Fibrosing Alopecia
Description
The speaker reviews the wide range of atypical clinical presentations of frontal fibrosing alopecia (FFA) and emphasizes red and yellow flags that help avoid missed diagnoses. They describe several recognized patterns, including diffuse, pseudofringe, linear, endogenetic alopecia-like, cockade-like, ophiasis-like, and the rare Upsilon pattern, noting that some cases can resemble androgenetic alopecia, traction alopecia, alopecia areata, or other scarring alopecias. Key warning signs include eyebrow loss, loss of vellus and body hair, temporal vein depression, pale frontal bands, lonely hairs, crown involvement, facial papules/pebbles, and lichen planopigmentosus or other facial hyperpigmentation. The talk highlights that occipital involvement is common and may be the only clue in some patients, and that men often present younger with beard and sideburn involvement. The speaker also discusses overlap or confusion with lupus and folliculitis decalvans, stressing that biopsy and trichoscopy are essential, and that clinicians should look beyond classic scalp recession to detect early or extrafollicular disease.
View moreConclusions
- Frontal fibrosing alopecia has multiple atypical clinical patterns, so relying only on the classic receding hairline can lead to missed diagnoses.
- Early red flags such as eyebrow loss, loss of vellus hair, lonely hairs, pale frontal bands, temporal vein depression, and body hair loss are key clues to recognition.
- Trichoscopy and biopsy are essential for confirming FFA, especially when the presentation mimics androgenetic alopecia, traction alopecia, alopecia areata, or other scarring alopecias.
- FFA can extend beyond the scalp and may involve the eyebrows, sideburns, beard, body hair, crown, and facial skin with papules or lichen planopigmentosus-like changes.
- Men and younger patients can develop FFA, and in men the disease may present earlier with beard and sideburn involvement.
- Lupus can closely mimic FFA or coexist with it, so clinicians should keep a broad differential diagnosis and not assume every frontal alopecia is FFA.
- Recognizing these unusual presentations earlier may improve diagnosis before irreversible scarring occurs.
- Piero della Francesca. Portrait of Battista Sforza (c. 1465–1472).#10.5040/9781350902046
- Unusual patterns of presentation of frontal fibrosing alopecia: A clinical and trichoscopic analysis of 98 patients.#10.1016/j.jaad.2017.02.012
- Vañó-Galván S et al. Depression of the frontal veins: A new clinical sign of frontal fibrosing alopecia. J Am Acad Dermatol. 2015.#10.1016/j.jaad.2015.02.1129
- It’s not all traction: the pseudo ‘fringe sign’ in frontal alopecia.#10.1111/bjd.14005
- Eyelash Involvement in Frontal Fibrosing Alopecia: A prospective study.#10.1016/j.jaad.2021.07.063
- Peripilar ‘Guttate’ Hypopigmentation of the Scalp and Idiopathic Guttate Hypomelanosis in Frontal Fibrosing Alopecia.#10.1159/000489794
- Frontal Fibrosing Alopecia in Men: A Review of the Literature.#10.20944/preprints202502.0341.v1
- Cutaneous Lupus Erythematosus Presenting as Frontal Fibrosing Alopecia: Report of 2 Patients.#10.1159/000475844
- Coexistence of frontal fibrosing alopecia and discoid lupus erythematosus of the scalp in 7 patients: just a coincidence?#10.1111/jdv.12642