Frontal fibrosing alopecia part II: Etiopathogenesis and management.

Ezzat, Raymond Z; Alenezi, Sarah; Miteva, Mariya · J Am Acad Dermatol · 2026

review · Level V

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Abstract

Frontal fibrosing alopecia poses a distinct dermatological challenge with epithelial-mesenchymal transition at its core, driving follicular cell transformation and fibrotic changes. Genetic studies highlight significant associations, while environmental triggers, such as implicated cosmetic products (sunblock, personal hair care products, and moisturizers) introduce complexity. Managing frontal fibrosing alopecia proves daunting due to its chronic and unpredictable nature. Treatment strategies, including combination therapies such as hydroxychloroquine, dutasteride, topical and intralesional steroids, and topical tacrolimus, offer hope in stabilizing the condition. Monitoring the disease progression may be challenging as no established guidelines exist; however, imaging techniques may offer help in the future.

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