Frontal Fibrosing Alopecia

A variant of Lichen Planopilaris (LPP), FFA most commonly affects postmenopausal women, causing band-like hair loss along the front hairline and eyebrow loss. Men may also be affected. Common scalp symptoms include itching, redness, or burning. The condition progresses gradually, but the degree of hair loss varies among individuals.

While the exact cause is still unknown, factors such as hormonal changes, genetic predisposition, and environmental triggers may play a role. Some studies have noted a correlation between certain cosmetics or sunscreens and the condition, but this reflects an association—not proof of cause.

Diagnosis

Diagnosis is based on a combination of the patient’s medical history, clinical examination, and a scalp biopsy, if needed, which confirms the presence of inflammation and scarring around the hair follicles. Blood tests may be performed to rule out other conditions.

Treatment Options

Consulting with a dermatologist early in the disease course is important to ensure the best possible management and outcome. Treatment focuses on halting disease progression, as regrowth in scarred areas is not possible.

• Topical/injected steroids
• Anti-inflammatory medications (Hydroxychloroquine or Doxycycline)
• Dutasteride (especially in postmenopausal women) ¹
• Minoxidil to support hair preservation
• JAK inhibitors in severe cases
• Hair transplant is not advised unless stable for 2+ years and often requires a repeat scalp biopsy to ensure the disease is inactive. Transplants into inflamed areas tend to fail or worsen the disease

Prognosis

The prognosis for FFA varies. While it is a chronic condition that can cause significant cosmetic and emotional distress, early diagnosis and treatment can help stabilize hair loss and alleviate symptoms. Ongoing management and regular follow-ups with a dermatologist are vital in maintaining scalp health and preventing further progression.