Frontal fibrosierende Alopezie – Fallbeispiele und Review

Zusammenfassung

Die frontal fibrosierende Alopezie (FFA) ist eine vernarbende Alopezie, welche klinisch durch Regression des frontotemporalen Haaransatzes, disseminiert verbleibende Haare (lonely hairs) und Verlust der Brauen gekennzeichnet ist. Meist sind postmenopausale, seltener auch jüngere Frauen betroffen und gelegentlich auch Männer. Der Verlauf ist variabel, oft sehr langsam und unbeachtet. Auch Spontanremissionen sind häufig. Daher lässt sich die Inzidenz nur schätzen, jedoch ist sie wahrscheinlich zunehmend. Es werden dafür Umweltfaktoren, Sonnencremes, aber auch eine optimierte Awareness und Diagnostik diskutiert. Allerdings blieb die Pathogenese der lymphozytären Follikulitis bisher noch ungeklärt. Klinisch ist die Haut im betroffenen bandförmigen Bereich atroph und weißlich. In floriden Bereichen sind follikuläre Erytheme und Keratosen typisch. Nicht selten sind kleine, wenig erythematöse Papeln an Stirn und Wangen assoziiert („facial papules“). Evidenzbasierte Therapien existieren nicht. Lokal werden Steroide, Calcineurin-Inhibitoren oder Minoxidil angewendet, systemisch 5α-Reduktase-Hemmer, Hydroxychloroquin und Doxycyclin.

Abstract

Frontal fibrosing alopecia (FFA) is a cicatricial alopecia characterized by the regression of the frontotemporal hairline, “lonely hairs” and reduction of eyebrows. Postmenopausal females are mostly affected, but rarely also younger females and sometimes males. The course is variable, often very slow and unrecognized. Spontaneous remission seems to exist. Thus, the incidence can only be estimated, but seems to increase in the last two decades. Regarding pathogenesis, environmental factors, sun screens, or improved awareness and diagnostics have been discussed. However, the pathogenesis of the underlying lymphocytic follicular inflammation is still a matter of discussion. Clinically, the skin of the involved areas is atrophic and pale, and within acute inflamed areas follicular erythemas and keratoses are typical. Small pale, reddish papules on the forehead and cheeks (“facial papules”) are not rare. There are no approved treatments yet. Local corticosteroids, calcineurin inhibitors and minoxidil are often used. Systemic treatment possibilities include 5α-reductase inhibitors, hydroxychloroquine and doxycycline.

Publication History

Article published online:
14 April 2021

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