Frontal Fibrosing Alopecia: Signs and Symptoms

If you’ve noticed hair loss along your frontal hairline that extends to the sides of your hairline, you could be dealing with a condition called frontal fibrosing alopecia (FFA). 

This condition causes you to lose hair in an almost ring-like shape around the perimeter of your hairline (also called the frontotemporal hairline) and is most common in postmenopausal women. Frontal fibrosing alopecia can present itself in premenopausal women, too — or women of any age, really. 

Not thrilled at the prospect of having a hairline that resembles the OG Queen Elizabeth? Can’t say we blame you. Prompt treatment will be key. 

Below, read up on what the signs and symptoms of FFA are, along with how it can be treated. 

What Is Frontal Fibrosing Alopecia?

Frontal fibrosing alopecia is a variant of lichen planopilaris, a condition that affects the scalp and hair and leads to hair loss.

FFA is characterized by a slow progression of hair loss near the forehead and sides of the head. Scarring can also occur, as can body hair involvement (meaning, hair loss affecting the eyebrows, eye lashes and other body parts). 

What exactly causes FFA is unknown. However, many believe that it is caused by a hormonal change or an autoimmune response. For the latter, it’s thought the immune system mistakenly attacks hair follicles. 

This condition most often affects women over 50 (i.e., post-menopausal women), which is why some healthcare professionals link it to hormone shifts. Women say they tend to notice FFA between two and 12 years after the start of menopause. However, it can start before menopause.

Signs and Symptoms of Frontal Fibrosing Alopecia 

If FFA goes untreated it can cause permanent hair loss. This makes noticing the signs and symptoms of it really important. After all, the sooner you catch it, the sooner you can treat it (more on that soon!). 

This type of hair loss has a tendency to develop slowly. One of the first noticeable signs of FFA is losing eyebrow hair. Up to 95 percent of women with FFA lose some (if not all) of their eyebrow hair.

When it comes to hair loss on your head, patients with FFA often experience a painful or itchy scalp. Some people also notice a rash forming along their hairline. 

From there, progressive hair loss around the hairline starts. If left untreated, the hairline will continue to recede and get worse. 

The skin around the receding hairline may look pale, shiny or even mildly scarred (which can lead to a form of scarring alopecia). 

In conjunction with a receding hairline, some people notice small facial papules (or bumps). In rare cases, people with white hair report having a few hairs grow in their natural color. Though, this is rare.  

Some women with FFA also have female pattern hair loss (also called female pattern baldness). This occurs when testosterone (yes, women have testosterone in their system) attaches to androgen receptors within the hair bulb and the dermal papilla. From there, hair follicles shrink which can lead to hair loss. 

Testosterone can also turn into dihydrotestosterone (DHT), which attaches to androgen receptors and prompt hair loss.

Female pattern hair loss combined with FFA can contribute to all-over hair thinning along with the receding hairline.

How to Treat Frontal Fibrosing Alopecia

Hair loss from FFA is permanent — which is why it’s so important to catch it as early as possible. Thankfully, once you know you have it, you can start medical therapies to stop it or, at least, slow it down. Here are some of the frontal fibrosing alopecia treatment options. 

Anti-Inflammatories

A healthcare professional will best be able to tell you how to address your FFA. They may start by giving you an anti-inflammatory medication. This is because hair loss associated with FFA is often thought to be caused by inflammation of the hair follicles. 

Possible anti-inflammatories that can help treat FFA include:

• Corticosteroid

• Tetracycline

• Hydroxychloroquine

Finasteride 

Another medication thought to help is finasteride. This prescription medication is a 5-alpha reductase inhibitor: It works by blocking certain hormones that can lead to hair loss. 

Research has found that taking finasteride (or another medication called dutasteride) prevents further hair loss in most people with FFA. 

Finasteride must be taken every day to be effective. Finasteride is also a common treatment option for pattern hair loss. 

Minoxidil 

Minoxidil likely won’t stop FFA on its own, but when used in conjunction with other FFA treatments, it can help with hair regrowth. Minoxidil is specifically thought to be helpful in conjunction with finasteride.

Topical minoxidil (and the brand name version, Rogaine®) doesn’t require a prescription and can be found in a 2% solution or 5% foam. 

It works by prompting your blood vessels to open so that more nutrients and oxygen can get to your hair. In addition, minoxidil helps lengthen the growth period for your hair. This means that more follicles are created to replace the hair you lose.

Laser Therapy

This is a new treatment option for FFA and more research needs to be done on it. It’s thought to reduce swelling and itchiness of the scalp caused by FFA. 

There has been one small study on laser therapy with 13 people. The researchers found that after being treated with a laser twice a week for an amount of time, patients had less inflammation and some noticed hair regrowth.

Laser treatment must be performed at a medical office. 

Dealing with Frontal Fibrosing Alopecia

If you notice a band of hair loss around the perimeter of your hairline, you may have a condition called frontal fibrosing alopecia (FFA). 

Experts believe this condition may be caused by an autoimmune response or by hormone changes. Women of any age can experience FFA, though it seems particularly prevalent in women over the age of 50. 

Along with hair loss, people with FFA may notice an itchy scalp, loss of eyebrows, facial papules, and mild scarring around the hairline. Body hair involvement may also be noticed; this means you may lose hair on other parts of your body. 

FFA can lead to permanent hair loss, so prompt treatment is a must. Medication (like anti-inflammatories and finasteride) and laser treatment may be options. 

If you suspect you may be dealing with frontal fibrosing alopecia, the first thing you should do is contact a healthcare professional to get a formal diagnosis. They will look at your symptoms (whether it be a receding hairline, facial papules or beyond) and determine if you have FFA. From there, you will be able to review medical treatments that can help.