What causes Frontal Fibrosing Alopecia?
Even though cases of FFA are on the rise, the exact cause of FFA is still unknown. However, genetic, hormonal, autoimmune, inflammatory, and environmental factors may contribute to FFA development [1].
Because FFA predominantly affects postmenopausal women, is commonly associated with androgenetic alopecia, and is responsive to 5-alpha-reductase inhibitors (anti-androgens), researchers have suggested that hormones could play a role in FFA [4]. However, FFA happens in people with normal hormonal balances, and hormone replacement therapy does not affect the disease [2]. Early menopause could contribute to the premature development of FFA or increase the risk of developing FFA [1].
Autoimmunity is thought to play a role in FFA as immune cells can attack the hair follicles, causing damage. Up to 30% of patients with FFA have an autoimmune disorder such as lupus, hypothyroidism, or psoriasis [5].
Similarly, genetic factors may lead to FFA, as it often affects several people in the same family; 8% of FFA cases are familial. However, studies have shown that it is not hereditary [6].
Environmental factors such as facial products, environmental toxins, viral infections, surgery or stress may play a role in developing FFA [1]. Studies have shown that using certain leave-on cosmetics, including facial sunscreens, hair care products, and hair dyes may contain ingredients that trigger and increase the incidence of FFA in genetically susceptible individuals [4,6].