Frontal fibrosing alopecia (FFA) is a form of hair loss with an unknown etiology seen in postmenopausal women. Its clinical presentation is characterized by alopecia along the frontal hairline that extends posteriorly with scarring. On examination, perifollicular hyperkeratosis and erythema may be present. Histologically, FFA is identical to lichen planopilaris. Unfortunately, there is no consistently effective treatment. Various treatment options may be tried, and eventually, patients may opt to use camouflage such as wigs to disguise the alopecia. In time, most cases will stabilize, with or without treatment. More research is needed not only to determine etiology but also to establish evidencebased treatment options for FFA.
Folliculitis decalvans is a cicatricial alopecia of the parietal scalp and vertex characterized by erythematous, scarred, confluent patches of alopecia with scattered peripheral pustules and scale. It is most common among middle-aged men and is frequently associated with acne keloidalis nuchae. The pathogenesis of folliculitis decalvans is not completely understood, but it likely involves an inappropriate inflammatory response to components of Staphylococcus aureus. Folliculitis decalvans is a chronic disease characterized by periods of remission and exacerbation. Patients with long-standing, undertreated disease can experience severe hair loss and postinflammatory hyperpigmentation. Treatment is focused on reducing inflammation and bacterial load using oral antibiotic therapy. Early recognition and treatment is paramount to alleviate symptoms and limit irreversible hair loss.
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