Frontal Fibrosing Alopecia: Causes, Symptoms, and Treatment
Frontal fibrosing alopecia (FFA) is a type of scarring hair loss that primarily affects the front hairline and eyebrows. This condition is increasingly recognized in dermatology clinics worldwide, particularly among postmenopausal women, although men and younger women can also be affected. Because FFA can lead to permanent hair loss, early detection and treatment are critical.
What is Frontal Fibrosing Alopecia?
Frontal fibrosing alopecia is a form of lichen planopilaris, an inflammatory condition that targets the hair follicles. Over time, inflammation destroys the follicles, leading to scarring alopecia—hair loss that is often irreversible.
FFA is characterized by a progressive, symmetric recession of the frontal hairline, often accompanied by eyebrow loss and sometimes body hair loss.
Who is at Risk for FFA?
FFA most commonly affects:
Postmenopausal women, typically between ages 50–70.
Individuals with a history of autoimmune diseases such as thyroid disorders or lupus.
Those with a genetic predisposition (family history of lichen planopilaris or autoimmune disorders).
However, FFA has also been reported in:
Premenopausal women.
Men, who may notice thinning or loss along the frontotemporal scalp.
Individuals of all ethnicities, though it appears more frequently in those with lighter skin types.
Possible Causes and Risk Factors
The exact cause of FFA remains unclear, but research suggests a combination of genetic, hormonal, and environmental factors. Potential contributors include:
Autoimmune reaction – the immune system attacks hair follicles.
Hormonal changes – particularly reduced estrogen after menopause.
Genetic susceptibility – family history may increase risk.
Environmental triggers – such as sunscreen ingredients or hair care products (being investigated but not proven).
Clinical Signs and Symptoms
Key features of frontal fibrosing alopecia include:
Symmetrical hairline recession – a band-like pattern of hair loss across the forehead.
Loss of eyebrows – one of the earliest and most common signs.
Scalp redness and scaling – indicating active inflammation.
Perifollicular hyperkeratosis – small rough bumps around hair follicles.
Itching, burning, or tenderness – though some patients have no symptoms.
Loss of body hair – arms, legs, and axillary hair may be affected in some cases.
Diagnosis of Frontal Fibrosing Alopecia
A dermatology provider can diagnose FFA based on clinical examination and sometimes scalp biopsy. Diagnostic steps include:
Medical history review – to identify symptoms, hormonal changes, or family history.
Scalp examination – to look for hairline recession, redness, and perifollicular changes.
Trichoscopy – a dermatoscope is used to examine the hair follicles more closely.
Biopsy – confirms inflammation and scarring typical of lichen planopilaris.
Early diagnosis is essential to slow progression and preserve remaining hair.
Treatment Options for Frontal Fibrosing Alopecia
Because FFA causes permanent hair loss, the main goal of treatment is to halt or slow disease progression.
1. Topical Treatments
Topical corticosteroids – reduce inflammation and redness.
Topical calcineurin inhibitors (tacrolimus, pimecrolimus) – non-steroidal options for long-term control.
Topical minoxidil – may help maintain remaining hair.
2. Oral Medications
Hydroxychloroquine – an antimalarial drug often used to suppress autoimmune inflammation.
Doxycycline or tetracycline antibiotics – have anti-inflammatory properties.
Finasteride or dutasteride – oral medications that block androgens and may slow hair loss.
Systemic corticosteroids – reserved for severe, rapidly progressive cases.
3. Intralesional Steroid Injections
Injected directly into inflamed areas to suppress localized activity.
4. Lifestyle and Supportive Care
Gentle hair care routines and avoiding harsh chemicals.
Camouflage techniques such as hair styling, wigs, or microblading for eyebrows.
Psychological support for those struggling with the emotional impact of hair loss.
Prognosis
FFA tends to progress slowly over years, eventually stabilizing. Unfortunately, regrowth in scarred areas is rare, which is why early diagnosis and treatment are key to preventing further loss.
When to See a Dermatology Provider
Seek medical advice if you notice:
Receding hairline, especially if accompanied by redness or scaling.
Eyebrow thinning or complete loss.
Itching or burning along the frontal scalp.
Family history of scarring alopecia and new-onset hair loss.
At My Skin St. Pete and My Skin Bradenton, Leah Michel, APRN, FNP-BC, offers expert evaluation and personalized treatment plans to slow FFA progression and help you preserve healthy hair as much as possible.
Final Thoughts
Frontal fibrosing alopecia can be distressing, but with early intervention and targeted therapy, its progression can often be slowed significantly. Partnering with a knowledgeable dermatology provider allows you to take control of your hair health and explore both medical and cosmetic solutions.
Disclaimer:
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