Frontal Fibrosing Alopecia (FFA) is a type of scarring hair loss that primarily affects the hairline on the scalp.
Frontal Fibrosing Alopecia (FFA) is a type of scarring hair loss that primarily affects the hairline on the scalp. While it most frequently affects postmenopausal women, younger women — and men — can also develop it.
Some researchers think the incidence of fibrosing alopecia in men is much higher than reported. It may get overlooked because it often shows up alongside androgenetic alopecia (AKA male pattern baldness).
FFA is a type of lichen planopilaris, belonging to the lichen planus family. It’s an unexplained scalp inflammation that results in scarring (AKA cicatricial alopecia) that damages hair follicles.
FFA causes the frontal hairline to recede and often leads to eyebrow loss. Some people also experience hair loss elsewhere on their body and other scalp-related symptoms.
FFA doesn’t cause the typical M- or V-shaped receding hairline that many men notice when they experience early signs of male pattern baldness.
Instead, frontal fibrosing alopecia symptoms might start with hairline recession around your temples and at the front of your hairline. FFA can also cause bald patches or hair loss that appears in a nonuniform zigzag pattern.
Beyond front thinning hair on your scalp, FFA can also affect hair in these areas:
Eyebrows
Eyelashes
Beard area
Underarms
Pubic area
Arms and legs
Before you even notice hair thinning in the front, FFA can cause other symptoms on your face and scalp, like:
Rash. Small bumps, red spots, or pimple-like facial papules may appear in areas where you’re losing hair. In some cases, this might cause pain, itching, or discomfort.
Perifollicular erythema. This is redness around the hair follicles in affected areas.
Skin discoloration: Skin along the receding hairline may look lighter or have a shiny appearance from scarring and lesions.
Hair color changes. Though rare and temporary, some people who have graying hair may notice a sudden return of strands of their natural hair color.
Just like any other health or hair loss issue, FFA is usually a mix of different factors. And these can vary from person to person.
Although the exact causes of front baldness are still unclear, here are some potential factors that may play a role in FFA.
FFA might be an autoimmune disorder where the immune system mistakenly attacks hair follicles, causing inflammation, scarring, and hair loss.
Alopecia areata is another type of hair loss that triggers hair loss through an autoimmune response.
FFA usually affects postmenopausal women, hinting that hormonal changes — especially those involving androgens (AKA male sex hormones) like testosterone — play a role.
FFA tends to run in families, suggesting a potential genetic link.
Some research suggests that environmental factors, like topical exposure to certain cosmetics, sunscreens, or other personal care products, may trigger or worsen frontal alopecia.
There may be a link between low vitamin D levels and certain hair disorders, but more research is needed.
Whether you’re experiencing hair loss or not, it’s a good idea to get your vitamin D levels checked once in a while to find out if you need to supplement.
Ongoing inflammation around your hair follicles can accelerate the scarring process, worsening FFA hair loss.
Anyone can experience FFA as they age, but the following factors can increase your risk:
Gender. FFA is more common in women, especially postmenopausal women, though it can also affect men and younger people.
Age. It usually affects people over age 40.
Ethnicity. FFA appears to be more prevalent in people of European descent.
Family history. If you have family members with FFA, you may be more likely to develop the condition.
Autoimmune disorders. Having other autoimmune conditions, like lupus, vitiligo, or thyroid disease, may increase FFA risk.
Hormonal changes. Experts believe that hormonal changes, especially due to menopause or androgens, play a significant role in FFA.
History of scalp conditions. If you’ve dealt with other scalp conditions, like fungal infections or inflammation, this may increase your likelihood of developing FFA.
Vitamin D deficiency. There may be a link between low vitamin D levels and various autoimmune conditions, including FFA.
Environmental factors. There might be an association between FFA risk and environmental triggers, including exposure to certain personal care products like sunscreens.
Getting an accurate diagnosis is a critical first step to managing and treating FFA. If you’re noticing any changes in your hair or scalp, it’s a good idea to consult a healthcare professional like a dermatologist or hair loss specialist.
Here are some of the steps you can expect your provider to take when diagnosing frontal fibrosing alopecia:
Physical exam. Your provider will probably start with a thorough examination of your hairline and scalp, looking for tell-tale signs like eyebrow loss, skin inflammation, and a receding hairline.
Health history. It’s helpful for your provider to understand your personal health and medical history as they consider a diagnosis.
Scalp biopsy. Healthcare professionals sometimes take a small sample of the affected scalp (AKA a biopsy) to examine it under a microscope to help make a diagnosis.
Trichoscopy. This is a non-invasive technique that uses a dermatoscope to examine the scalp at a high magnification.
Blood tests. Blood tests can’t specifically diagnose FFA, but they can help rule out other underlying conditions that could trigger hair loss, like a thyroid disorder or vitamin deficiency.
Options for frontal fibrosing alopecia treatment typically include anti-inflammatory medications, hormonal therapies, and other approaches to help preserve your existing hair and slow or stop current symptoms.
While there’s no known cure for FFA, the following frontal baldness treatment options may help prevent further hair loss:
Topical corticosteroids. Steroid creams or ointments that you apply directly to your scalp may help reduce inflammation and slow hair loss.
Calcineurin inhibitors. Medications like tacrolimus or pimecrolimus suppress your immune system activity. You can apply these topically to reduce inflammation and prevent further hair loss.
Minoxidil. Topical minoxidil (available as a liquid solution or minoxidil foam) may stimulate hair growth in men with FFA and other types of hair loss. It’s also available in an oral pill form.
Anti-inflammatory drugs. Steroids or other immunosuppressive medications can help control the body’s autoimmune response and reduce inflammation.
Finasteride. This is an FDA-approved medication for treating male pattern hair loss. Because dihydrotestosterone (DHT), a male hormone that can lead to hair loss, doesn’t trigger FFA, antiandrogen medications like finasteride aren’t typically effective at stopping it or stimulating hairline regrowth. However, it may be helpful if you’re also experiencing male pattern baldness.
Antimalarial drugs. Doctors sometimes prescribe hydroxychloroquine to treat autoimmune-related conditions because it can help limit inflammation — and prevent scarring in the case of FFA.
Dutasteride. This is a type of 5-alpha-reductase inhibitor, a class of drugs that healthcare professionals prescribe for an enlarged prostate. However, one study found that oral dutasteride was effective for FFA-related hair loss without notable side effects — but it’s worth noting that most of the 224 participants were women.
Antibiotics. While antibiotics don’t treat FFA directly, drugs like doxycycline or minocycline may help reduce inflammation.
Hair transplant. Hair transplantation may be an option for some men with FFA. This is when a surgeon relocates hair-producing parts of your scalp to areas with thinning or balding.
Wigs or eyebrow tattooing. Some people find that cosmetic solutions like eyebrow tattoos, micropigmentation, or hairpieces are helpful for boosting self-confidence.
Ultraviolet (UV) light therapy. UV treatments (AKA phototherapy) may help reduce inflammation and promote hair regrowth.
Lifestyle modifications. Doing things in your everyday life that help protect your hair and scalp can reduce scalp irritation and hair loss. For instance, swapping out harsh hair care products for gentler ones and wearing sun protection.
Consult your provider. Communicate with your dermatologist if you notice new or persistent symptoms or treatment side effects — or just don’t feel like your treatment plan is working.
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There’s no guaranteed way to prevent FFA or other hair loss conditions, but the following habits may help slow or prevent future hair loss:
Protect your scalp from the sun. Use a broad-spectrum sunscreen on your scalp or wear a wide-brimmed hat to protect the hairline and scalp from UV damage, which may worsen inflammation.
Avoid harsh hair care. Ditch chemical-laden hair dyes and other harsh styling products for mild, sulfate-free shampoos and conditioners. Your hair also appreciates gentle care, so avoid excessive brushing or heat-styling. If you have long hair, try to minimize pulling, as this can cause traction alopecia.
Manage existing health conditions. If you have another autoimmune disease or hormone-related condition, make sure you’re properly addressing it with help from your healthcare provider.
Address vitamin D deficiency. There’s an association between low vitamin D and autoimmune diseases, so get your blood levels checked and supplement if needed.
Avoid skin irritants. Be cautious when applying products directly to the scalp, like sunscreens or cosmetics containing irritants that can trigger FFA in some people.
Treat your scalp well. Keep the scalp clean and free from excess oils or buildup, which can cause inflammation or block hair follicles, making the scalp more susceptible to autoimmune attacks.
If you see something, say something (sooner than later). Earlier interventions can help minimize further hair loss, scarring, and damage to your scalp.Tell your dermatology expert if you notice anything out of the ordinary.
Learn more in our guides on scarring alopecia and autoimmune diseases that can cause hair loss, and explore our hair loss treatments for men.
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