Frontal Fibrosing Alopecia and Lichen Planus Pilare: Diagnosis, Symptoms, and Treatment

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02What is Frontal Fibrosing Alopecia (FFA)?

Frontal Fibrosing Alopecia (FFA) is a dermatologic condition that manifests as progressive hair loss, mainly along the frontal edge of the hairline. This condition is classified as a form of scarring alopecia, as the disease process leads to the replacement of hair follicles with scar tissue, thus preventing hair regrowth. Originally described in 1994, FFA has seen a significant increase in cases, predominantly among postmenopausal women, although there is no shortage of reports in men and younger individuals.

Lichen Planus Pilare (LPP) and its Manifestations

Lichen Planus Pilare (LPP) is a chronic inflammatory condition of an autoimmune nature, considered a variant of Lichen Planus. This condition is characterized by perifollicular inflammation, manifested by the appearance of erythematous and itchy papules on the scalp. Progression of the disease can lead to thinning of the skin and ultimately to permanent hair loss due to scarring atrophy. Common symptoms include itching, pain, burning, scaling, and the formation of papules, with hair thinning typically beginning at the forehead.

Clinical Diagnosis of FFA and LPP

The diagnosis of FFA and LPP is based primarily on clinical observation by a dermatologist or specialist surgeon. During the examination, the physician will evaluate the scalp for distinctive signs of disease, such as inflammation of the tissue and characteristic erythematous papules. In some cases, a skin biopsy may be necessary to confirm the diagnosis and assess the extent of damage to the hair follicles. The correct diagnosis is crucial for the development of a targeted treatment plan.

Therapeutic Strategies for FFA and LPP

Treatment of FFA and LPP primarily aims to slow the progression of hair loss and manage associated symptoms. Treatment options include the use of topical corticosteroids to reduce inflammation and immunosuppressive drugs to modulate the immune response. Laser therapies and the use of drugs such as Finasteride and Minoxidil have shown efficacy in slowing hair loss. In severe cases, hair transplantation may offer a solution to restore hair density in affected areas.

Prevention and Long-Term Management

Although there are no definitive prevention methods for FFA and LPP, taking precautionary measures such as avoiding excessive use of harsh chemicals on the hair and maintaining a healthy lifestyle can help reduce the risk of developing these conditions. It is also important to protect against prolonged exposure to ultraviolet rays, which can aggravate symptoms and cause further damage to the scalp. Effective management of these conditions requires a multidisciplinary approach and ongoing collaboration with a dermatology specialist to monitor the evolution of the condition and adjust treatment to the patient’s needs.
In conclusion, Alopecia Fibrosante Frontalis and Lichen Planus Pilare represent significant challenges in the field of dermatology, with a major impact on patients’ quality of life. Continued research and advancement of medical knowledge are critical to developing new therapeutic strategies and improving the long-term outlook for those with these complex conditions.

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Dr. Vincenzo Masullo
Il Dr. Masullo Vincenzo consegue la sua laurea in Medicina e Chirurgia presso la II Università degli Studi di Napoli. Spinto dalla sua passione, investe con dedizione nella sua formazione accademica, con la specializzazione in Microbiologia, sempre presso l’ateneo di Napoli, poi in Dermochirurgia e Chirurgia della Calvizie, presso l’Università degli Studi di Firenze. E’ membro delle più importanti associazione di settore: membro votante dell’ISHRS una delle più rilevanti organizzazioni mondiali nell’ambito della chirurgia della calvizie; è membro della World FUE Institute, della S.I.Tri. (Società Italiana di Tricologia) e di altre importanti organizzazioni del settore. Ha un’esperienza trentennale nell’ambito della chirurgia: nel 1992 le sue prime esperienze professionali chirurgiche in collaborazione, il Dr Masullo, oggi, è tra i più stimati chirurghi specializzati del trapianto di capelli con tecnica FUE. Il Dr. Masullo, pur ritenendo la Tecnica FUT (Strip Extraction) valida, con risultati indiscutibilmente ottimi, nel 2007 sceglie di utilizzare la Tecnica FUE (Follicular Unit Extraction), considerandola molto meno invasiva e più funzionale anche a quelle che erano le richieste dei pazienti, specializzandosi e divenendo un punto di riferimento nel campo. Il Dr Masullo utilizza un micro punch manuale del diametro di 0,6 / 0,8 millimetri riducendo la traumaticità alle unità follicolari nell’atto della estrazione.


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