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Frontal Fibrosing Alopecia: Symptoms, Causes and Treatment

Knox Beasley, MD

Reviewed by Knox Beasley, MD

Written by Steph Coelho

Published 03/17/2023

Updated 04/26/2024

Hair loss near the hairline is most often male pattern baldness (androgenetic alopecia). Another possible culprit? Frontal fibrosing alopecia, a form of hair loss that looks like pattern baldness but involves scarred, damaged hair follicles.

Receding hair? You’re not alone. Hair loss can happen at any age, and a receding hairline is one of the most common first signs of hair thinning

Early frontal fibrosing alopecia treatment can prevent this type of hair loss from getting worse. Let’s dig into the distinct symptoms, causes and treatments for hair thinning in front of your head.

Frontal fibrosing alopecia is a type of hair loss that affects the frontal scalp, eyebrows and eyelashes. It’s categorized as lichen planopilaris, a form of lichen planus (unexplained skin inflammation) affecting the scalp. It causes cicatricial alopecia, scarring on the scalp that damages hair follicles.

Sorry for all the clinical jargon. We just want to be accurate, so bear with us.

Alopecia is a clinical term for hair loss. Frontal fibrosing alopecia is a specific type of scarring alopecia that physically destroys hair follicles — the tiny, tunnel-like structures in the scalp from which hair strands grow — and stops the hair growth cycle dead in its tracks.

As these follicles are destroyed, you might notice that your frontotemporal hairline looks thinner and less defined than usual or that your eyebrows are thinning.

The most common symptom of frontal fibrosing alopecia is hair loss around your frontal scalp or hairline. You might notice your hairline creeping backward, with a band of skin starting to appear where your frontmost hair follicles once were.

Unlike male pattern baldness, FFA doesn’t necessarily cause the classic M- or V-shaped receding hairline many men first notice in their 20s, 30s or 40s. 

Instead, you may see hair loss at the front of your hairline, around your temples. Frontal fibrosing alopecia could also cause bald patches on your scalp or hair loss that develops in an uneven, zigzag pattern.

Beyond hair loss near the front of your scalp, FFA can also affect your:

  • Eyebrows

  • Eyelashes

  • Beard area

  • Underarms

  • Pubic area

  • Arms and legs

Some people with this inflammatory form of hair thinning report sparse or complete loss of eyebrows as an early first sign of hair loss.

Frontal fibrosing alopecia can also cause other symptoms on your face and scalp. Before you experience any hair loss, you might notice:

  • A rash on your hairline, forehead or face. You may notice small bumps, red spots or facial papules (small, pimple-like growths) near affected areas where you’re losing hair.

  • Perifollicular erythema. Perifollicular redness or redness around the hair follicle can occur with FFA.

  • Itchy, uncomfortable or painful skin. In some cases, the rash that develops with frontal fibrosing alopecia might cause pain, itching or discomfort.

Although uncommon, frontal fibrosing alopecia may cause a sudden return of natural hair color in a few strands for folks with white or gray hair.

The symptoms of fibrosis hair loss can vary in severity and type. And they can happen all over the body or only in certain parts of the scalp or face. No matter where it happens, hair loss is usually slow.

That said, this type of hair loss is permanent, so it’s crucial to act quickly if you notice any of the symptoms listed above.

Medical professionals still aren’t completely sure what causes frontal fibrosing alopecia.

Experts theorize that one likely cause of FFA is an autoimmune reaction, meaning it might develop when the immune system targets and damages hair follicles.

You may have a higher risk of developing frontal fibrosing alopecia if you have another autoimmune disease, like lupus, vitiligo or hypothyroidism.

Your risk for frontal fibrosing alopecia could also be higher if you have a family member with this type of hair loss or if you have type 2 diabetes or rosacea.

The current scientific research isn’t entirely clear on what triggers frontal fibrosing alopecia. But some evidence suggests that environmental factors — such as pollution, skin creams, sunscreen, stressful events and surgery — may play a role.

Frontal fibrosing alopecia is generally considered a rare condition. Though the exact prevalence isn’t totally known, the number of diagnoses around the world appears to be growing.

Most people diagnosed with FFA are women, but men can get it too.

FFA primarily affects women, especially postmenopausal women. However, premenopausal women of African descent might get it sooner — sometimes as early as in their 20s but often decades later.

Frontal fibrosing alopecia can also occur in men of all ages and ethnic backgrounds. 

The first step in treating frontal fibrosing alopecia is seeing a hair-loss specialist for an accurate diagnosis.

You can start by reaching out to your primary care provider. They can refer you to a dermatologist, a medical professional specializing in skin, hair and nail issues.

To diagnose FFA, your dermatologist may examine your hairline, face and other areas where you’ve lost hair. They might ask about your symptoms, like when you first noticed hair loss or if your face and hairline feel painful.

During your dermatology appointment, your provider might remove a small piece of tissue from your scalp (aka a biopsy) to check for signs of frontal fibrosing alopecia.

If a biopsy is necessary, your scalp will be treated with a topical anesthetic to prevent pain or discomfort.

It’s important to see a dermatologist if you’re concerned about hair loss since it’s easy to mistake the signs of frontal fibrosing alopecia for androgenetic alopecia, traction alopecia or alopecia areata.

Hair Loss Medication

This is where hair regrowth starts

Because frontal fibrosing alopecia physically damages hair follicles, no magic pill can regrow hair once it’s gone. Sorry to be the bearer of bad news.

But if you notice the signs of frontal fibrosing alopecia early and start treatment before it gets bad, you might be able to stabilize your hairline and stop losing hair. Treatment can also relieve related issues like skin irritation, itching and discomfort.

Treatment of frontal fibrosing alopecia may involve:

  • Intralesional corticosteroid injections. These medications reduce inflammation. Your healthcare provider may inject corticosteroids into areas of your scalp and face with signs of hair loss. Using corticosteroids might improve your hair health and reverse eyebrow loss.

  • Hydroxychloroquine. This medication helps control irritation, itching and pain caused by frontal fibrosing alopecia. Some people find that their hair loss slows down or stabilizes after starting treatment with this medication.

  • Dutasteride. Part of the drug class 5-alpha-reductase inhibitors, doctors usually prescribe this medication to treat enlarged prostate. It may also help prevent a worsening receding hairline. A 2021 study of 224 mostly female participants found that dutasteride was effective in stabilizing FFA-related hair loss without any notable side effects.

  • Antibiotics. Antibiotics like doxycycline or tetracycline may provide relief from symptoms of frontal fibrosing alopecia, including inflammation. However, studies on the effectiveness of doxycycline are mixed. Plus, antibiotics come with potential side effects.

  • Immunosuppressants. There’s not enough research to support the use of mycophenolate mofetil, a type of immunosuppressant medication, for FFA. But one small study found that three of five participants saw improvement in their condition.

  • Minoxidil. This topical medication can stimulate hair growth in people with frontal fibrosing alopecia and other types of hair loss. In some instances, your healthcare provider may prescribe an oral form of minoxidil to take on an ongoing basis, usually in combination with other hair loss treatments.

We offer minoxidil liquid solution and minoxidil foam as part of our complete range of hair loss treatments for men.

Does Finasteride Work for Frontal Fibrosing Alopecia?

Since frontal fibrosing alopecia isn’t caused by dihydrotestosterone (DHT), a male hormone that can lead to hair loss, antiandrogen medications like finasteride generally aren’t effective at stopping it — or stimulating hairline regrowth.

However, if you experience male pattern baldness at the same time as frontal fibrosing alopecia, finasteride may help reduce the severity of your hair loss, stimulate regrowth and prevent things from getting worse.

Hair transplantation may be an option for those who experience permanent hair loss due to FFA.

If a healthcare professional prescribes medication to treat frontal fibrosing alopecia, make sure to use it as directed. Stopping the medication, adjusting your dosage or using it on an inconsistent basis could actually make hair loss progress.

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Are Vitamins for Frontal Fibrosing Alopecia Effective?

There’s currently no scientific evidence to suggest that vitamins can stop frontal fibrosing alopecia, slow it down or repair damaged hair follicles. 

There’s also no evidence that following a specific diet will prevent this type of hair loss or speed up hair regrowth.

Still, many vitamins do offer general hair health benefits. So taking a vitamin supplement or eating a nutrient-rich diet could help strengthen any hair unaffected by frontal fibrosing alopecia.

Learn more about whether hair vitamins actually work in our guide.

So, you have FFA. What’s next? Are you destined to lose all your hair?

The prognosis varies from person to person, but hair loss typically worsens if left untreated. Hair lost as a result of frontal fibrosing alopecia usually won’t grow back.

Hair loss treatments, delivered

Incidences of frontal fibrosing alopecia are less common than male pattern baldness, but the condition can have an even more severe impact on your hair if left untreated.

If you notice hair loss affecting your hairline, eyebrows, facial hair or body, it’s best to talk to a healthcare professional as soon as possible.

When it comes to frontal fibrosing alopecia, there are a few things to remember:

  • You aren’t to blame for losing hair. We still don’t know exactly what causes frontal fibrosing alopecia, but it’s clear that everyday haircare habits and hairstyles don’t play a major role in this type of hairline recession. Your skincare habits won’t make a difference, either.

  • It’s easy to mistake for male or female pattern hair loss. Since this form of hair loss often starts near the frontal hairline, it’s easy to mistake it for male pattern baldness.

  • It’s possible to stop it from progressing. If your healthcare provider prescribes medication, be sure to take it. While this type of hair loss isn’t reversible, it can often be controlled with ongoing care and treatment. 

If you’re worried about frontal fibrosing alopecia, get help by talking to your primary care provider or scheduling an appointment with a dermatologist. 

What about other forms of hair loss, like male pattern baldness? You can do an online consultation with a healthcare provider and get personalized recommendations and prescription treatments, if necessary.

To learn more about protecting your hair, check out our blog posts on how to prevent hair loss, why hair can fall out and simple ways to know if you’re balding.

9 Sources

  1. Lichen Planopilaris: Hair Loss, Symptoms & Treatment. (2022, December 15). Cleveland Clinic. Retrieved from https://my.clevelandclinic.org/health/diseases/24537-lichen-planopilaris
  2. Frontal fibrosing alopecia. (2021, November 8). Retrieved from https://rarediseases.info.nih.gov/diseases/10886/frontal-fibrosing-alopecia
  3. Hair Loss Types: Frontal Fibrosing Alopecia Overview. (n.d.). Retrieved from https://www.aad.org/public/diseases/hair-loss/types/frontal-fibrosing-alopecia
  4. Litaiem, N. & Idoudi, S. (2022, August 8). Frontal Fibrosing Alopecia. StatPearls. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK519001/
  5. Hair Loss Types: Frontal Fibrosing Alopecia Overview. (n.d.). Retrieved from https://www.aad.org/public/diseases/hair-loss/types/frontal-fibrosing-alopecia
  6. Hair Loss Types: Frontal Fibrosing Alopecia Signs and Symptoms. (n.d.). Retrieved from https://www.aad.org/public/diseases/hair-loss/types/frontal-fibrosing-alopecia/symptoms
  7. Hair Loss Types: Frontal Fibrosing Alopecia Causes. (n.d.). Retrieved from https://www.aad.org/public/diseases/hair-loss/types/frontal-fibrosing-alopecia/causes
  8. Porriño-Bustamante, M.L., Fernández-Pugnaire, M.A. & Arias-Santiago, S. (2021, May). Frontal Fibrosing Alopecia: A Review. Journal of Clinical Medicine. 10 (9), 1805. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8122646/
  9. Hair Loss Types; Frontal Fibrosing Alopecia Diagnosis and Treatment. (n.d.). Retrieved from https://www.aad.org/public/diseases/hair-loss/types/frontal-fibrosing-alopecia/treatment
Editorial Standards

Hims & Hers has strict sourcing guidelines to ensure our content is accurate and current. We rely on peer-reviewed studies, academic research institutions, and medical associations. We strive to use primary sources and refrain from using tertiary references. See a mistake? Let us know at [email protected]!

This article is for informational purposes only and does not constitute medical advice. The information contained herein is not a substitute for and should never be relied upon for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment. Learn more about our editorial standards here.

Knox Beasley, MD

Dr. Knox Beasley is a board certified dermatologist specializing in hair loss. He completed his undergraduate studies at the United States Military Academy at West Point, NY, and subsequently attended medical school at Tulane University School of Medicine in New Orleans, LA. 

Dr. Beasley first began doing telemedicine during his dermatology residency in 2013 with the military, helping to diagnose dermatologic conditions in soldiers all over the world. 

Dr. Beasley is board certified by the American Board of Dermatology, and is a Fellow of the American Academy of Dermatology.

Originally from Nashville, TN, Dr. Beasley currently lives in North Carolina and enjoys spending time outdoors (with sunscreen of course) with his wife and two children in his spare time. 

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  • Dermatology Residency. San Antonio Uniformed Services Health Education Consortium

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