Frontal Fibrosing Alopecia: Symptoms, Causes and Treatment

If you’ve noticed your hairline starting to recede, you’re not alone. Hair loss can occur in men of all ages, and a receding hairline is one of the most common early signs that your hair is beginning to thin. 

Most of the time, hair loss that occurs near your hairline is caused by male pattern baldness, or androgenetic alopecia. But in some cases, it can be caused by a type of hair loss called frontal fibrosing alopecia.

Frontal fibrosing alopecia, or FFA, is a type of hair loss that occurs when the hair follicles around the front of your scalp are damaged by scarring. It’s a form of lichen planopilaris, an inflammatory condition that’s believed to be caused by your immune system.

Frontal fibrosing alopecia can look similar to male pattern baldness, but it’s a very different form of hair loss that usually requires a distinct, personalized approach to treatment. 

The good news is that if you catch the signs of frontal fibrosing alopecia early, it’s often possible to “stabilize” this form of hair loss and prevent it from getting worse.

Below, we’ve talked about what frontal fibrosing alopecia is, as well as the symptoms you might notice if you have this form of hair loss.

We’ve also covered the treatment options that are currently available to control this form of hair loss, protect your frontal hairline and help you to achieve and maintain healthy hair growth over the long term.

What is Frontal Fibrosing Alopecia?

Frontal fibrosing alopecia is a type of hair loss that can affect your frontal scalp, eyebrows and eyelashes. It’s a frontal variant of lichen planopilaris, a skin disease that causes scarring on the scalp that can affect your hair follicles.

“Alopecia” is a clinical term for hair loss. As a specific type of scarring alopecia, frontal fibrosing alopecia physically destroys hair follicles, the tiny, tunnel-like structures in your scalp from which hair strands grow.

As these follicles are destroyed, you may notice that your frontotemporal hairline begins to look thinner and less defined than normal, or that your eyebrows start to lose hair. 

FFA primarily affects women, especially postmenopausal women, although it may start earlier in women of African descent. However, it can also occur in men of all ages and ethnic backgrounds. 

Symptoms of Frontal Fibrosing Alopecia

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

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

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

In addition to 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 frontal fibrosing alopecia report noticing thinning or loss of eyebrows as an early first sign of hair loss.

This type of hair loss is permanent, meaning it’s important to act quickly if you notice any of the signs of hair loss and follicular damage listed above. 

In addition to causing permanent loss of hair, frontal fibrosing alopecia can cause other symptoms that may affect your face and scalp. Before you even notice any hair loss, you might see:

• A rash that affects your hairline, forehead and/or face. You may notice small bumps, red spots and facial papules (small, pimple-like growths) that develop near areas of skin where you're losing hair.

• Itchy, uncomfortable or painful skin. In some cases, the rash that can develop as part of frontal fibrosing alopecia may cause pain, itching or discomfort.

Although uncommon, in people with white or gray hair, frontal fibrosing alopecia may result in a sudden return of natural hair color in a few strands of hair. You may notice that some of your hair follicles begin to grow new hairs that look like they did prior to graying.

The symptoms of frontal fibrosing alopecia can vary in severity and type, and can happen all over the body or only in certain parts of the scalp or face. There may also be body hair involvement, but not in everyone. However, no matter where it happens, hair loss is usually slow.

What Causes Frontal Fibrosing Alopecia?

Medical professionals still aren’t completely aware of what causes frontal fibrosing alopecia to develop, although they believe it has several causes for most people. 

One likely cause of FFA is an autoimmune reaction or disease, meaning it might develop as a result of your immune system targeting and damaging your hair follicles.

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

You may also be more at risk of frontal fibrosing alopecia if you have a family member with this type of hair loss, or if you have type 2 diabetes or rosacea.

Although current scientific research isn’t totally clear on what triggers frontal fibrosing alopecia, some research suggests that environmental factors, such as toxins, skin creams, sunscreen, stressful events and surgery, may be involved.

Frontal Fibrosing Alopecia Treatment Options

Because frontal fibrosing alopecia involves physical damage to your hair follicles, there’s no pill that you can take to “regrow” hair once it’s gone.

However, if you notice the signs of frontal fibrosing alopecia early and start treatment before it becomes severe, you may be able to stabilize your hairline, stop losing hair and improve your quality of life. 

Diagnosing Frontal Fibrosing Alopecia

The first step in treating frontal fibrosing alopecia is to talk to a hair loss specialist and receive an accurate diagnosis.

If you’re worried about this form of hair loss, it’s best to talk to your primary care provider. They can refer you to a dermatologist — a type of medical professional who specializes in treating issues that affect your skin, nails and hair.

To diagnose FFA, your dermatologist may perform a physical exam to look at your hairline, face and other areas where you’ve lost hair. They may ask about your symptoms, such as when you first began to notice hair loss or if your face and/or hairline feel painful.

In some cases, your dermatologist might remove a small piece of tissue from your scalp (a type of procedure called a biopsy) to check for signs of frontal fibrosing alopecia.

This procedure is usually performed in the dermatologist’s office. Your scalp will be treated with a topical anesthetic, meaning you won’t feel any significant pain or discomfort.

It’s important to see a dermatologist if you’re concerned about losing hair, as it’s easy to mistake the signs of frontal fibrosing alopecia for androgenetic alopecia.

Treatments for Frontal Fibrosing Alopecia

Unlike with other forms of hair loss, there’s no way to regrow most hair that’s lost as a result of frontal fibrosing alopecia. This is because once your hair follicles are damaged due to scarring, they’re usually unable to produce new, healthy hairs.

However, it’s often possible to prevent this type of hair loss from becoming worse and get relief from issues such as skin irritation, itching and discomfort.

Your healthcare provider may suggest a clinical approach to treatment using one or several of the following medications:

• Corticosteroids. These medications reduce inflammation. Your healthcare provider may inject corticosteroids into areas of your scalp and face that show signs of hair loss. Using corticosteroids may help to improve your hair health and reverse eyebrow loss.

• Hydroxychloroquine. This medication is used to 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.

• Minoxidil. This topical medication, which is also commonly used to treat other types of hair loss, might help to stimulate hair growth. In certain cases, your healthcare provider may prescribe an oral form of minoxidil for you to take on an ongoing basis, usually in combination with other hair loss treatments.
  We offer minoxidil solution and minoxidil foam as part of our complete range of hair loss treatments for men. 

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

However, if you start to experience male pattern baldness at the same time as frontal fibrosing alopecia, using finasteride may help to reduce the severity of your hair loss, stimulate regrowth or prevent your hair loss from getting worse — but just the hair loss or loss of hair density caused by the male pattern baldness.

If you’re prescribed medication to treat frontal fibrosing alopecia, make sure to use it as directed by your healthcare provider. Stopping the medication, adjusting your dosage or using medication on an inconsistent basis may cause your hair loss to continue progressing. 

Are Vitamins for Frontal Fibrosing Alopecia Effective?

Currently, there’s no scientific evidence to suggest that vitamins can stop frontal fibrosing alopecia, slow down this type of hair loss 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 regrowth of your hair. 

However, many vitamins do offer benefits for your general hair health, which means that taking a vitamin supplement or eating a vitamin-rich diet may help to strengthen any hairs that aren’t affected by frontal fibrosing alopecia or other forms of hair loss.

You can learn more about vitamins and your hair’s health, strength and thickness in our guide to whether or not hair vitamins actually work. 

Understanding Frontal Fibrosing Alopecia

Frontal fibrosing alopecia is less common than male pattern baldness, but it can have an even more severe impact on your hair if it’s left untreated.

If you start to notice hair loss that affects your hairline, eyebrows, facial hair and body, it’s best to talk to your healthcare provider as soon as you can. 

When it comes to frontal fibrosing alopecia, there are a few things you’ll want 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 normal hair care habits don’t play a major role. 

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

• It’s often possible to stop it from progressing. If your healthcare provider prescribes medication, make 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, you can access help by talking to your primary care provider or scheduling an appointment with a dermatologist. 

For other forms of hair loss, such as male pattern baldness, you can take part in a consultation with a healthcare provider online to get started protecting your follicles and preventing your hair from further thinning. 

Finally, if you’d like 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 check if you’re beginning to develop baldness.