Frontal fibrosing alopecia (FFA) is a scarring type of hair loss, and the number of people affected appears to be increasing. In a new research study, scientists at King’s College London have found a rare interaction between genes which leads to greater risk of Frontal Fibrosing Alopecia.

In women from the UK and Spain, those who had certain versions of the genes HLA-B and ERAP1 were more likely to be affected by FFA. Genes form the blueprints for building proteins. The proteins made from these genes are involved in the immune system, and help it sense whether something in our body is our own (and should be left alone) or is a foreign invader like a virus (and so should be destroyed). In people with FFA, errors in this mechanism may contribute to hair follicles being attacked by the immune system.

A similar interaction between these genes is observed in other inflammatory conditions like ankylosing spondylitis (AS), birdshot uveitis, Behcet’s disease, and psoriasis. Further research will be needed to determine if genetic testing can help us predict development and symptoms of FFA. This may also lead to further understanding about which treatments will work best. In people with AS who have one version of HLA-B, higher involvement from a specific immune cell population was found, which has now led to a clinical trial testing of a targeted treatment. Further research on FFA may similarly discover promising targets for treatment.

Alongside genetics, environmental factors may also play a role in developing FFA. A previous study found that oral contraception use is associated with a greater risk for FFA in people with a variant in the CYP1B1 gene, which is involved in the processing of hormones. There also is an ongoing debate among researchers about the role of personal care products and sunscreens in triggering FFA, however evidence on this is not yet clear.

Alopecia UK previously funded Dr Tziotzios and Dr Rayinda to help them collect DNA samples from people with FFA. The new findings are part of a larger project on FFA which was supported by the British Skin Foundation and Medical Research Council. A news article on the FFA research by King’s College London provides more information.