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Frontal fibrosing alopecia, also known as FFA, is a scarring hair loss where the frontal and temple area hairline recedes. The causes of the FFA are still unknown, yet it is believed to be an autoimmune disease where the immune system attacks the hair follicles, causing FFA. Other causes could be genetics, hormonal imbalances, certain medications or surgery. FFA does not have curative treatment options, but the progression of hair loss can be slowed with certain medical interventions. slowed down with certain treatments.
Hair fall can seem normal initially. However, when the frontal hairline starts receding, that’s when the concern begins. When the front and temple areas lose hair, leaving a shiny, smooth forehead, it could be due to frontal fibrosing alopecia. This is scarring hair loss where the immune system accidentally damages the hair follicles. Now to know if you are dealing with FFA, you need to understand what frontal fibrosing alopecia is, its symptoms, causes and the treatment options.
What is Frontal Fibrosing Alopecia?
Frontal fibrosing alopecia is a condition in which you lose hair from the front and side of your scalp. It may also cause eyebrow hair loss over time. There’s no permanent treatment for this condition, but your doctor can help you slow down the hair loss. Unlike other hair loss conditions, you won’t be able to restore the hair lost due to frontal fibrosing alopecia. FFA predominantly affects postmenopausal women, typically presenting between the ages of 50 and 70, though it can also occur in males and premenopausal women.
What Are the Symptoms of Frontal Fibrosing Alopecia?
Noticing the early signs of frontal fibrosing alopecia, like gradual thinning of hair along your forehead, temples, or eyebrows, can make a big difference in getting the right diagnosis quickly. Even if your skin seems normal, you might also notice some of the other symptoms listed below.
- Pale, smooth and shiny frontal area
- Losing eyebrow hair (One of the earliest signs)
- Itchy skin or a painful scalp
- Visible forehead veins (Due to loss of dermal thickness)
- Facial bumps & hyperpigmentation
In rare cases, individuals experience ‘canities reversal’, a phenomenon where existing white hair shafts undergo repigmentation due to surrounding inflammation. Scientists are still trying to figure out the cause of this phenomenon. The leading theory says this happens because of inflammation around hair follicles, which accidentally activates dormant melanocyte stem cells.
FFA is a systemic condition that can also affect other body parts, such as the hair on the arms and legs, causing symmetric thinning. You may also see loss of eyelashes and hair thinning in the underarms as a symptom of FFA.
Causes of Frontal Fibrosing Alopecia
The cause of FFA is still unknown, but doctors believe the following factors may contribute to the condition.
- The body’s immune system mistakenly attacks the hair follicles
- Genetics, FFA may be transferred from a family member
- Imbalanced hormonal reactions
- Surgeries such as a hair transplant
In addition to these, there’s a debate claiming that FFA can also be caused by facial sunscreen and moisturiser. According to studies, using sunscreen is actively being researched as a potential trigger, though it is not yet proven to be a direct cause of FFA. Frontal fibrosing alopecia causes hairline receding, making the area open to sun exposure. That probably makes people use more sunscreen to save their skin from UV rays. However, no study has proven that sunscreen causes FFA.
When to See a Doctor for FFA?
You should immediately consult your doctor when you see the initial signs of hair loss. This includes a receding hairline at the front and temple, losing eyebrow hair, or if you have an itchy and painful scalp. You should not attempt traditional remedies to treat the condition, as they unnecessarily delay medical treatment and worsen the condition. If you want to prevent permanent hair loss, professional evaluation and early intervention with a targeted frontal fibrosing alopecia treatment plan are the only effective options.
Diagnosis of Frontal Fibrosing Alopecia
Your doctor will ask about your family history, medical history, the medications you are currently taking, and when you first noticed visible hair loss. Your doctor will also do a physical examination, such as checking the eyebrow, hairline, and scalp area.
A skin biopsy may be required if your doctor suspects FFA. They are likely to numb a small area of your scalp, take a small sample of your skin, and examine it under the microscope. This will help them understand the current state of your FFA condition.
A hair-pull test may also be performed to evaluate the anchoring stability and integrity of your hair roots. They will also examine the bumps you have on your face.
Management & Frontal Fibrosing Alopecia Treatment
There’s no treatment for restoring hair loss in frontal fibrosing alopecia. However, certain procedures can help slow down the progression of hair loss. Here are certain medicines that are expected to be prescribed.
- Antibiotics such as doxycycline and minocycline to reduce inflammation.
- Finasteride or dutasteride is prescribed to prevent more hair loss.
- Hydroxychloroquine to reduce symptoms of itchiness and pain.
- Minoxidil is a topical treatment that increases the anagen phase and helps keep your remaining hair in its active growth stage longer, so it doesn't shed as quickly.
However, since FFA is a scarring alopecia, hair transplantation cannot be recommended during this phase, as the immune system can affect newly implanted grafts.
Difference Between FFA vs. Traction Alopecia
Frontal fibrosing alopecia is a hair loss condition, whereas traction alopecia is a mechanical condition. Though they have certain similarities in the symptoms. The table below will help you understand the difference between frontal fibrosing alopecia and traction alopecia so you can get the right diagnosis and care.
|
Frontal Fibrosing Alopecia |
Traction Alopecia |
|
It happens when the immune system attacks the hair follicles |
It happens due to extensive hair-pulling |
|
Receding hairlines in the front and temple areas |
Hair loss happens around the temples and edges |
|
It is a permanent scarring of hair loss |
It is a non-scarring hair loss |
|
This happens to people, especially women, above the age of 50 |
This happens to people who usually have a tight hairstyle |
|
Have visible redness, itchiness, and eyebrow hair loss |
Broken hair, bumps, and tenderness are the common signs |
|
It requires hair loss treatment and medication to manage |
Avoid tight hairstyles and reduce the stretch on the scalp |
|
You permanently lose hair in this condition |
It can become permanent if you don’t stop doing tight hairstyles |
What to Avoid for Frontal Fibrosing Alopecia?
Prevention tips are crucial before and after the treatment. Though FFA doesn’t have treatment options, ignoring the symptoms or certain habits can worsen the condition. Here are certain habits you must avoid for frontal fibrosing alopecia.
- Avoid managing the condition with home remedies.
- Stop using hairstyling tools such as hair dryers, curling irons and straightening tools for the time being.
- Avoid wearing accessories such as harsh wig glues, tight clips or hats.
Traya’s Perspective on Frontal Fibrosing Alopecia
Initially, frontal fibrosing alopecia has common symptoms as other hair loss, such as a receding hairline and hair shedding. It can confuse people, and they might mistake the FFA symptoms for other conditions. Hair shedding usually leads people to try home remedies instead of looking for proper consultation and knowing the root cause of hair loss.
In the case of frontal fibrosing alopecia, if the condition is treated initially, people can save their hair from permanent damage. Therefore, understanding the underlying causes becomes crucial. Traya’s Hair test identifies the root cause of hair loss and creates a personalised hair kit to treat the condition without mistaking it with other hair loss types.
Since FFA gradually progresses, it would be difficult for you to understand whether you are dealing with it. Early doctor consultation can help in preventing excessive hair loss, slowing down the effect. This condition mainly happens in people, especially women above the age of 50. It also happens in men, but the percentage of it is lower than in women. It may also happen in young people in rare cases.
Frequently Asked Questions
Q1. What do I expect if I have frontal fibrosing alopecia?
You can expect hair loss in your frontal areas, along with the sides of the scalp and eyebrows. If treatment is not done after the initial symptoms, they can cause permanent hair loss.
Q2. How do I cure my frontal fibrosing alopecia?
Frontal fibrosing alopecia is a scarring hair loss condition with no permanent treatment options. However, you can slow down the hair loss with the treatment. The hairline stops receding after the procedure and may grow baby hair temporarily.
Q3. What are the early-stage frontal fibrosing alopecia symptoms?
The early-stage symptoms of frontal fibrosing alopecia are a receding hairline, eyebrow loss, and scalp discomfort. Once these symptoms are visible, consulting a doctor immediately may help prevent permanent hair loss.
Q4. What autoimmune disease causes frontal fibrosing alopecia?
Dermatologists classify frontal fibrosing alopecia as an autoimmune condition and a distinct clinical variant of Lichen Planopilaris (LPP). In this case, the immune system attacks the hair follicles, which causes inflammation and scarring hair loss.
Q5. What are the vitamins for frontal fibrosing alopecia?
Vitamins can’t treat frontal fibrosing alopecia, but they can help in supporting hair health and managing deficiencies. Your doctor may recommend vitamin D, B complex, and antioxidants such as vitamin A, C, and E, depending on your reports.
Q6. Does frontal fibrosing alopecia male presentation occur?
While FFA affects women who are above 50 or 60 years of age, it can also happen to males, though the chances of it happening to males are less.
References:
- https://my.clevelandclinic.org/health/diseases/23316-frontal-fibrosing-alopecia
- https://www.ncbi.nlm.nih.gov/books/NBK519001/
- https://jsstd.org/frontal-fibrosing-alopecia-an-overview/
- https://dermatrials.medicine.iu.edu/blogs/frontal-fibrosing-alopecia-scarring-hair-loss-guide
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