Frontal fibrosing alopecia (FFA) is a progressive form of primary cicatricial alopecia with characteristic hairline recession. Histologically it resembles:

• A Alopecia areata — peribulbar lymphocytic infiltrate ('swarm of bees')
• B Discoid lupus erythematosus — interface dermatitis with mucin
• C Traction alopecia — trichomalacia and pigment casts
• D Lichen planopilaris — lymphocytic follicular destruction with fibrosis at the isthmus ✓

Explanation

Frontal fibrosing alopecia (FFA) is now considered a variant of lichen planopilaris (LPP). Histologically both show a lichenoid lymphocytic infiltrate targeting the follicular isthmus with concentric lamellar fibrosis leading to permanent scarring alopecia. FFA specifically affects the frontotemporal hairline with a 'band' of recession, eyebrow loss, and a 'lonely hair' sign (solitary vellus hairs at the receding margin). Clinically it affects predominantly postmenopausal women; sunscreen use on the scalp margin is a recently identified protective factor.

Reference: Neena Khanna Illustrated Synopsis of Dermatology & STD, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.