Frontal fibrosing alopecia is a type of scarring alopecia which is not exactly well understood. A band-like pattern of hair loss is commonly seen along the scalp’s front, and it can leave permanent scars from which no hair growth will take place.
In this guide, you will learn more about the causes, risk factors, symptoms and treatments for frontal fibrosing alopecia.
What Is Frontal Fibrosing Alopecia?
Frontal fibrosing alopecia (FFA) is a type of patterned scarring alopecia that permanently damages the hair follicle, replacing it with scar tissue. Mainly, it affects the hairline, but it can also occur on the sides and back of the head.
Clinical manifestation of frontal fibrosing alopecia (FFA). (A,B) Pattern I of FFA. (C) Pattern II of FFA. (D) Pattern III of FFA, the pseudofringe sign. Miao YJ, Jing J, Du XF, Mao MQ, Yang XS, Lv ZF. Frontal fibrosing alopecia: A review of disease pathogenesis. Front Med (Lausanne). 2022 Jul 25;9:911944. doi: 10.3389/fmed.2022.911944. PMID: 35957858; PMCID: PMC9357920/Creative Commons License
According to DermNet NZ, FFA can make the hairline recede by 1.8-2.6 cm on the scalp. But this condition is not just limited to the scalp. It can also cause eyelash and eyebrow hair loss. Additionally, it can cause body hair loss.
Frontal fibrosing alopecia was first described in 1994 by Australian pathologist Steven Kossard. According to him, it was a type of lichen planopilaris, but it is widely debated as there are differences between the two conditions.
Interestingly, the prevalence of this condition has been increasing since the 90s. It is not exactly understood why. Some suggest that it’s a result of wearing sunscreen, but others argue against it.
This type of hair loss more commonly affects postmenopausal women around the age of 56. However, it can also occur in premenopausal women and men (usually affects the beard and sideburns) of all ages and ethnicities.
Since it progresses quite slowly, it can take a couple of years or more for a person to even notice that they’re experiencing frontal hair loss.
What Causes Frontal Fibrosing Alopecia?
The exact cause of frontal fibrosing alopecia isn’t known. However, according to a 2025 review, frontal fibrosing alopecia is believed to have an “autoimmune basis influenced by genetic, hormonal, and environmental factors.”
Some people who have FFA have a family history of this condition. However, the fact that it affects post-menopausal women quite commonly points towards the involvement of hormones. However, even that has been brought into question because of reported cases of frontal fibrosing alopecia in men and premenopausal women, according to one research.
As for environmental factors, one study notes that particles like titanium dioxide found on the hair shafts of those with frontal fibrosing alopecia are believed to cause this condition. The researchers also remarked that studies show a link between greater use of moisturisers and sunscreens among those with this scarring alopecia, with a higher rate of allergic reactions to allergens in personal care products.
What Are The Risk Factors For Frontal Fibrosing Alopecia?
One study published in Clinical and Experimental Dermatology found the following risk factors for frontal fibrosing alopecia:
- Hormonal changes (pregnancy, hormone replacement therapy and raloxifene)
- Simultaneously coexisting medical conditions (hypothyroidism, lichen planus pigmentosus and rosacea)
- Environmental factors (facial sunscreens, antiageing creams and occupational exposure)
Frontal fibrosing alopecia has also been shown to coexist with other types of hair loss, including androgenetic alopecia, lichen planopilaris, discoid lupus erythematosus and alopecia areata, according to another study.
What Are The Symptoms of FFA?
If you have frontal fibrosing alopecia, it may have the following signs and symptoms:
- Progressive hair loss at the front
- Loss of eyebrow/eyelash hair
- Body hair loss
- Scarring
- Pain
- Itchiness
- Red, scaly skin around the hair follicle
- Hypopigmentation or hyperpigmentation
- Burning sensation on the scalp (trichodynia)
- Skin-coloured papules on the face
- Lonely hair signs (isolated terminal hair)
- Pale, smooth, & shiny-looking bald areas
According to a study published in the British Journal of Dermatology, the kind of symptoms that more commonly appear can differ between males and females. It notes that androgenetic alopecia, body hair loss, and facial papules in FFA are more likely to occur in males.
It is also possible for FFA to be asymptomatic.
How Is FFA Diagnosed?
To diagnose frontal fibrosing alopecia, your doctor will begin with a physical exam.
The colour of the skin on the scalp may be lighter than that on the forehead. The skin can appear shiny with no visible hair follicles.
The doctor may also perform a pull test to see how much hair falls out. Most commonly though a biopsy is done.
In a biopsy, a small piece of skin tissue will be removed from the scalp so it can be closely examined in a lab. This will help rule out other similar types of hair loss and confirm the diagnosis for FFA.
Does Frontal Fibrosing Alopecia Cause Permanent Hair Loss?
Unfortunately, hair loss caused by frontal fibrosing alopecia is permanent. Once the scar tissue forms in place of the follicle, no hair growth will take place from there. The rate of hair loss can vary between people, but it usually takes years; it cannot be predicted. Eventually, though, it stops all of a sudden and goes into remission.
According to a study published in the Mayo Clinic Proceedings, on average, it can take 1.8 years to reach the point of remission. Before that, some treatments can help protect your hair.
How To Treat Frontal Fibrosing Alopecia?
Currently, there is no cure for frontal fibrosing alopecia, but it may be possible to manage its symptoms through various medications.
Usually, topical steroids are prescribed, but if the target area is small steroids may be injected instead. Other than that, topical calcineurin inhibitors (TCIs) are also prescribed for settling down the inflammation resulting from FFA.
Orally, the following kind of drugs are usually given:
- Antibiotics
- Steroids
- Hydroxychloroquine
- Immunosuppressants
Minoxidil and finasteride are also prescribed for hair loss but it needs to be monitored very strictly. Also, the success rates of these treatments vary.
In any case, if you have any symptoms of this condition, you should seek treatment as quickly as possible.
Is Hair Transplant Possible In Frontal Fibrosing Alopecia?
Frontal fibrosing alopecia patients can undergo hair transplantation. It is only possible after the condition has been in remission for a few years. It is important to know, however, that the success rate of the surgery may be lower than usual.
In one study, 51 patients with FFA had hair surgery with the FUT and FUE techniques of transplantation. Their graft survival rate was 87% in the first year but dropped to 41% after 5 years; even so, they were highly satisfied with the results, as reported in a review published in Clinical, Cosmetic and Investigational Dermatology.
If you’re planning to have a hair transplant with FFA, make sure to discuss the graft survival rate with your surgeon, along with other risks and complications.
How To Care For Your Hair With Frontal Fibrosing Alopecia?
FFA itself is very damaging, but you should make sure to not harm your hair in any other way. For that, you can consider doing the following:
- Wear loose hairstyles as tight hairstyles can cause traction alopecia which will exacerbate your hair loss.
- Do not use heat styling products like curlers, straighteners and dryers excessively. That’s because heat can stimulate inflammation which can worsen your condition.
- Be gentle with your hair and discuss with your doctor the kind of hair/skin products that you can use.
Experiencing Hair Loss?
Since 2012 Longevita has been facilitating your hair loss treatment journey. If you’re interested in starting your journey, do not hesitate to get in touch with us.
Frequently Asked Questions
Frontal fibrosing alopecia was once considered a rare type of hair loss. However, its incidence has been reportedly increasing. According to one review, it is the most common type of scarring hair loss around the world.
With treatment, it is possible to stop frontal fibrosing alopecia from causing further hair loss. However, you should get in touch with a doctor as soon as possible.
According to a review published in Frontiers in Medicine, stress has been suggested as a potential trigger for frontal fibrosing alopecia. However, it is imperative that you get a proper diagnosis for your hair loss from a medical professional.
Yes, frontal fibrosing alopecia can cause itchiness, among other symptoms.
No, unfortunately, frontal fibrosing alopecia is permanent and irreversible. However, it may be possible for you to prevent further hair loss with proper treatment.
Frontal fibrosing alopecia can last for a few years, and then it can stop on its own.
Frontal fibrosing alopecia might be mistaken for other types of hair loss, such as androgenetic alopecia (pattern baldness), alopecia areata or even traction alopecia. For an accurate diagnosis, you need to seek the help of a medical professional.
Dr Cagla
Dr Cagla earned her medical degree at Trakya University’s Faculty of Medicine in Bulgaria and has almost 6 years of hair transplantation experience. She is a specialist in FUE, DHI and Sapphire hair transplants of the scalp, eyebrows and beard and has performed over 6,000 surgeries. Dr Cagla is multilingual, with fluency in English, Bulgarian and Turkish.
