Abstract：
Despite a significant increase in reported cases of frontal fibrosing alopecia (FFA) in literature, discussion about the possible role of environmental factors, instruction for diagnosis and guideline for treatment, are limited. The review aims to provide a detailed synthesis of this condition that could be used by clinicians in their practise. Whether single-centre or multi-centre, studies of more than 60 cases less than 5 years old were mainly taken into consideration. Results obtained were that FFA affects mainly postmenopausal Caucasian women; the most common comorbidities are hyperlipidaemia, arterial hypertension, osteoporosis, hypothyroidism, depression, alongside dermatological disorders such as atopic dermatitis, rosacea, seborrheic dermatitis and androgenetic alopecia. Autoimmune, genetic, hormonal (e.g. estrogen deficiency, pregnancy, lactation, HRT and raloxifene) and environmental (e.g. daily use of facial sunscreens and less frequent use of hair dyes and shampoo) hypotheses were proposed for pathogenesis, as well as association with various predisposing factors (patient\'s health-social profile, disease\'s history and comorbidities). Clinical presentation of FFA can be divided into 3 specific patterns, each with a different prognosis. Diagnosis is usually made clinically with the use of trichoscopy; however, scalp biopsy remains the gold standard. The condition is regarded as a variant of lichen planopilaris (LPP) due to the similarity of the prominent histopathological findings, but the clinical image is distinct and therapeutic options vary. 5α-reductase inhibitors, intralesional steroids, and hydroxychloroquine provide the highest level of evidence for the treatment of FFA. The conclusion is that a better understanding of the disease is crucial for proper disease management.
摘要：
尽管文献中报道的额叶纤维性脱发（FFA）病例显着增加，讨论环境因素的可能作用，诊断指导和治疗指南，是有限的。该综述旨在提供这种情况的详细综合，可供临床医生在实践中使用。无论是单中心还是多中心，主要考虑了60例5岁以下病例的研究。获得的结果是，FFA主要影响绝经后高加索妇女；最常见的合并症是高脂血症，动脉高血压,骨质疏松,甲状腺功能减退,抑郁症,除了皮肤病，如特应性皮炎，酒渣鼻,脂溢性皮炎和雄激素性脱发。自身免疫,遗传,荷尔蒙(例如雌激素缺乏，怀孕,哺乳期,HRT和雷洛昔芬）和环境（例如每天使用面部防晒霜和较少使用染发剂和洗发水）假说被提出用于发病机理，以及与各种诱发因素(患者的健康-社会概况，疾病史和合并症)。FFA的临床表现可分为3种具体模式，每个都有不同的预后。诊断通常是在临床上使用内窥镜检查;然而，头皮活检仍是金标准。由于突出的组织病理学发现的相似性，该疾病被认为是扁平苔藓（LPP）的变体，但是临床图像是不同的，治疗方案也各不相同。5α-还原酶抑制剂，病灶内类固醇,和羟氯喹为FFA的治疗提供了最高水平的证据。结论是，更好地了解疾病对于正确的疾病管理至关重要。
