The Causes and Treatment of Frontal Fibrosing Alopecia

This cause of hair loss occurs most often in women

Senior woman combing her hair
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Frontal fibrosing alopecia is a condition that causes hair loss (alopecia) at the front of the scalp and near the temples, but treatment of FFA varies and cannot regrow hair.

In addition to loss of hair on the scalp and at the temples, the condition may also cause hair loss of the eyebrows and underarms and other areas of the body. FFA is most common in post-menopausal women but can also occur in women of all ages as well as men.

FFA is often asymptomatic but can cause itching or, in rare cases, pain.

How Is Frontal Fibrosing Alopecia Diagnosed?

The diagnosis of frontal fibrosing alopecia is typically made clinically. This diagnosis is made based on the pattern of hair loss. Other things your physician may look for are redness around the hair follicles (the “roots” of the hair), scales around hair follicles and subtle scarring in the area of hair loss.

Your physician may also refer to the “lonely hair sign,” which is seen when one hair remains in an area of hair loss. This is a common finding in frontal fibrosing alopecia. To confirm the diagnosis, your dermatologist may need to perform a biopsy to examine the hair follicles and the cells around them.  Frontal fibrosing alopecia was first described relatively recently (1994), and it is being recognized with increasing frequency.

What Causes Frontal Fibrosing Alopecia?

The exact cause of frontal fibrosing alopecia is still an area of active research.

It is likely that both hormonal changes and the immune system play a role in FFA. The fact that this kind of alopecia is most common among post-menopausal women supports the thought that hormones and hormonal balance contribute to the disorder.

Frontal fibrosing alopecia is considered a subtype of another disease called lichen planopilaris (LPP), a disorder causing hair loss that is known to be autoimmune.

The appearance of frontal fibrosing alopecia under the microscope resembles that of lichen planopilaris. The similarities between frontal fibrosing alopecia and lichen planopilaris suggest that autoimmunity may play a role. One study has also found that 30 percent of individuals with frontal fibrosing alopecia had another autoimmune disease (MacDonald et al, 2012).

Prognosis for Patients

The course of frontal fibrosing alopecia can be variable. It is typically slowly progressive, and hair loss does stop in some patients. FFA is a scarring form of alopecia, which means that hair follicles that are lost do not grow back.

How Is FFA Treated?

There is no standard therapy for frontal fibrosing alopecia. Treatments that have been used with some success include strong steroids, either applied topically or injected into the scalp, and finasteride or dutasteride (a 5-alpha reductase inhibitor), which has anti-androgen effects. Certain antibiotics (doxycycline and minocycline) can also be of use in treating frontal fibrosing alopecia. Even though frontal fibrosing alopecia is not caused by an infection, these antibiotics are beneficial because of their anti-inflammatory effects.

Another treatment is hydroxychloroquine.

Sometimes several treatments are combined to try to increase the effect. Treatment has been documented to halt or slow progression of hair loss, but no therapy has been definitively associated with regrowth of hair.


Kossard S. Postmenopausal frontal fibrosing alopecia: scarring alopecia in a pattern distribution. Arch Dermatol. 1994;130:770-774.

Ladizinski B, Bazakas A, Selim MA, Olsen EA. Frontal fibrosing alopecia: A retrospective review of 19 patients seen at Duke University. J Am Acad Dermatol. 2013; 68:749-755.

MacDonald A, Clark C, Holmes S. Frontal fibrosing alopecia: A review of 60 cases. J Am Acad Dermatol. 2012;67:955-961.

Vano-Galvan S, Molina-Ruiz AM, Serrano-Falcon C, Arias-Santiago S, Rodrigues-Barata AR, Farnacho-Saucedo G, Martorell-Galatayud A, Fernandez-Crehuet P, Grimalt R, Aranegui B, Grillo E, Diaz-Ley B, Salido R, Perez-Gala S, Serrano S, Moreno JC, Jaen P, Camacho FM. Frontal fibrosing alopecia: A multicenter review of 355 patients. J Am Acad Dermatol. 2014;70:670-678.

“Frontal Fibrosing Alopecia.” Genetic and Rare Diseases Information Center, Office of Rare Diseases Research. National Institutes of Health: National Center for Advancing Translational Sciences.

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