Derm Cases · Medicine
OSCE — Frontal fibrosing alopecia (FFA)
Eight-minute OSCE station on Frontal fibrosing alopecia (FFA): focused history, examination priorities, investigations, emergency and definitive management.
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Study tools
Target exams
Brief (to candidate)
You will assess a patient with a presentation consistent with Frontal fibrosing alopecia (FFA).
You have 8 minutes to take a focused history, outline examination, investigations, and management including red flags.
Clinical context
Frontal fibrosing alopecia (FFA) is a primary lymphocytic scarring (cicatricial) alopecia characterised by progressive, symmetric recession of the frontal and temporal hairline, predominantly in post-menopausal Caucasian women. First described by Kossard in 1994, it is considered a clinical variant of lichen planopilaris (LPP). Clinical hallmarks include perifollicular erythema and hyperkeratosis at the active hairline margin, loss of eyebrows (approximately 50 to 80 percent), and lonely hairs (isolated terminal hairs within the receded zone). Histology reveals a perifollicular lymphocytic (lichenoid) infiltrate around the upper follicle with basaloid degeneration, loss of sebaceous glands, and concentric perifollicular fibrosis.
[1]Candidate tasks
- Clarify onset, severity, associated features, and red-flag symptoms.
- State focused examination priorities.
- List first-line investigations and any named score/criteria.
- Give immediate resuscitation steps.
- Outline definitive management with doses/routes where standard.
- Name complications and disposition (ward / HDU / theatre / discharge safety-net).
- Mention one special-population modifier (pregnancy, child, elderly, CKD).
Examiner checklist
| Domain | Pass behaviours |
|---|---|
| Definition | Correct working diagnosis language |
| Assessment | Focused, prioritised, red flags sought |
| Investigations | Appropriate first-line + interpretation |
| Emergency care | ABC / time-critical actions first |
| Definitive care | Specific drugs/procedures, not generic phrases |
| Safety | Rapidly progressive FFA with more than 1 cm recession in 6 months — escalate to systemic therapy |
| Safety | Associated lichen planus features (oral mucosal lesions, nail changes, widespread cutaneous disease) — examine beyond the scalp |
| Safety | Atypical presentation with erythematous plaques, follicular plugging, or scarring alopecia elsewhere — reconsider mimics and biopsy |
| Communication | Clear plan and safety-netting |
Model outline
Lead with the working diagnosis and life threats. Resuscitate before definitive tests when unstable. Use guideline-standard therapy with named agents and doses. Document escalation criteria and follow-up. A safe candidate is specific, structured, and never delays critical care for non-urgent imaging.[1]
References3ShowHide
- [1]Fechine COC, Valente NYS, Romiti R Lichen planopilaris and frontal fibrosing alopecia: review and update of diagnostic and therapeutic features An Bras Dermatol, 2022.PMID 35379508
- [2]Lajevardi V, Ghiasi M, Balighi K, et al. Efficacy and safety of oral pioglitazone in the management of lichen planopilaris in comparison with clobetasol: A randomized clinical trial Dermatol Ther, 2022.PMID 36169160
- [4]Saceda-Corralo D, Combalia A, Fernandez-Crehuet P, et al. Consensus Document on the Clinical Management of Frontal Fibrosing Alopecia: Recommendations From Spanish Working Group on Trichology and Onychology of the AEDV Actas Dermosifiliogr, 2026.PMID 41344613