What Is Frontal Fibrosing Alopecia?

  • Rajni Sarma MBBS, MD from North-Eastern Hill University, India

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Introduction

Frontal Fibrosing Alopecia (FFA) is a rare type of scarring hair loss that primarily impacts the front of the scalp, including the forehead hairline. It is characterised by a gradual, progressive recession of the hairline and the loss of eyebrow hair.1,2,3,4

FFA is more common in women, particularly postmenopausal women, although it can affect men and individuals of all ages as well. The exact cause of FFA remains unclear, but researchers believe it may involve a combination of genetic, hormonal, and environmental factors.1,2,3,4

Understanding the causes

The precise cause of FFA is not yet fully understood, but researchers agree on several factors that may contribute to its development, such as hormonal changes, genetics, and environmental and autoimmune (body's defence system) factors.1,2

  • Hormonal changes: As is the case with most functions in our bodies, hormones play a significant role in hair growth and loss. Some studies suggest that hormonal changes, particularly the decrease in oestrogen levels that occur during menopause, may be linked to the onset of FFA in women.1,2,4
  • Genetics: There is evidence to suggest that genetics may play a role in FFA. Thus, individuals with a family history of the condition may have a higher risk of coming across FFA at some point in their lives.1
  • Autoimmune factors: Autoimmune disorders happen when the body attacks its own parts, in this case, the hair follicles, instead of the foreign things that it should be attacking,. It is also believed that FFA may have an autoimmune component, where the body's immune system mistakenly targets and damages hair follicles.1,2,4
  • Environmental factors: The world around us and the chemicals we use in our daily lives also affect our bodies. Chemicals such as sunscreens or skincare products containing chemical UV filters have been suggested as potential triggers for FFA in some individuals. However, more research is needed to establish a clear link.1,2

Symptoms of frontal fibrosing alopecia

Identifying FFA in its early stages can be challenging because the condition progresses slowly. Although symptoms may differ from person to person, receding hairline, thinning of the eyebrows, redness or itching on the scalp, loss of eyelashes and other facial hair and further skin abnormalities are some symptoms to watch out for.1,2,4

  • Receding hairline: FFA often begins with a subtle recession of the hairline along the forehead. This is a gradual hair loss, meaning it can increase over time.
  • Scalp redness and itching: Redness and itching in the affected areas of the scalp are also very common symptoms. These symptoms can be uncomfortable and lead to further hair loss due to scratching.
  • Eyebrow thinning: Thinning or complete loss of eyebrows is very common in individuals with FFA, and it is often characterised as waxy eyebrows.
  • Sparse or absent eyelashes: In addition to eyebrow thinning, eyelashes may also become sparse or disappear altogether in some individuals.
  • Facial hair loss: FFA may also extend to affect other areas of the face, leading to the loss of facial hair, such as sideburns or hair at the temples.
  • Further skin changes: The affected skin may appear pale, smooth, and shiny. It can also show signs of inflammation or scaling.

Diagnosis of frontal fibrosing alopecia

If you are experiencing any of the symptoms above, it is natural to suspect you may have FFA. However, it is essential to consult a dermatologist or your healthcare professional for a proper diagnosis. This is particularly important because sometimes different conditions present with similar symptoms, and they may require very different approaches to treatment and management.

Diagnosis typically involves a thorough medical history review where you will be asked a series of questions regarding your health, a physical examination of the scalp and affected areas, and sometimes a biopsy (taking a small piece of the affected area for testing) of the scalp skin to confirm the presence of scarring and inflammation.3

Early diagnosis is crucial because it can lead to more effective treatment options and help slow down or stop the progression of the condition.

Treatment options for frontal fibrosing alopecia

While there is no cure for Frontal Fibrosing Alopecia, several treatment options can help manage the condition and potentially promote some hair regrowth. The treatment choice depends on the individual's specific symptoms and the severity of the condition. Your healthcare provider might suggest treatments such as:

  • Topical corticosteroids– Dermatologists often prescribe topical corticosteroid creams or ointments to reduce inflammation and itching in the affected areas. These can help slow down the progression of FFA and may promote hair regrowth, especially if started early.3,4
  • Oral medications– In some cases, especially if the doctors think the FFA is linked to the autoimmune system, oral medications like immunosuppressants may be recommended to suppress the immune response. These medications can have potential side effects, so their use should be carefully monitored by a healthcare provider.3,4
  • Platelet-rich plasma (PRP) therapy– PRP therapy involves injecting a concentrated solution of the patient's blood platelets into the affected scalp areas. This is thought to promote hair growth by stimulating the hair follicles.5
  • Hormone replacement therapy (HRT)- For postmenopausal women, hormone replacement therapy may be considered to address hormonal imbalances that could be contributing to FFA. HRT should be discussed with your physician, as it carries its own set of risks and benefits.4
  • Hair transplantation– In cases where hair loss is stable, hair transplantation surgery can be an option to restore hair to the affected areas. This involves taking hair follicles from donor sites and implanting them into the affected scalp areas. The treatments mentioned above may be used before and/or after hair transplantation.3,4
  • Camouflage techniques– Although this is not a treatment, cosmetics and camouflage techniques, such as wigs, hairpieces, or makeup, can help individuals with FFA manage the visible effects of hair loss to boost their confidence and help with their morale. 3

It's important to note that each individual is different and that the effectiveness of these treatments can vary from person to person. Some individuals may respond well to one treatment option, while others may require a combination of approaches to manage their FFA effectively.4

Coping with frontal fibrosing alopecia

Not all the effects of FFA are cosmetic. Dealing with hair loss, especially in a visible area like the forehead and eyebrows, can be emotionally challenging.4,5 Mental health support, such as online communities and support groups, can provide emotional support and practical advice.

Taking the right steps towards self care such as eating a balanced diet, getting regular exercise, and managing stress can also help promote a positive outlook on one's life to improve morale and reduce stress. Visible effects of FFA are the most important aspect for many individuals. Cosmetics, wigs and clothing accessories may help manage these aspects.

FAQs

  1. What is Frontal Fibrosing Alopecia)?

It is a rare type of hair loss that primarily affects the front of the scalp, including the forehead hairline. It is characterised by a gradual recession of the hairline and the loss of eyebrow hair.

  1. Who is most at risk of developing FFA?

Frontal Fibrosing Alopecia is more common in women, especially postmenopausal women, although it can affect men and individuals of all ages as well. Those with a family history of the condition may have a higher risk.

  1. What causes FFA?

The exact cause of FFA is not yet fully understood, but it is believed to involve hormonal changes, genetics, and potentially autoimmune factors. Some environmental factors may also play a role.

  1. Is FFA a reversible condition?

Frontal Fibrosing Alopecia is not typically reversible, but with early diagnosis and appropriate treatment, it may be possible to slow down or halt its progression and promote some hair regrowth.3

  1. What should I do if I suspect I have FFA?

If you suspect you have FFA or experience its symptoms, it is crucial to consult a dermatologist or healthcare professional for a proper diagnosis and treatment plan.

  1. What are the treatment options for FFA?

Treatment options for FFA may include topical corticosteroids, oral medications, Platelet-rich plasma (PRP) therapy, hormone replacement therapy (HRT), hair transplantation, and cosmetic solutions like wigs or makeup. The choice of management depends on individual circumstances.

  1. Can FFA be prevented?

There is currently no known way to prevent FFA, as its exact cause still needs to be fully understood. However, seeking early medical advice and adopting a healthy lifestyle may help manage the condition effectively.

  1. Are there any experimental or emerging treatments for FFA?

Research into FFA is ongoing, and there may be emerging treatments in the future. However, it's essential to discuss treatment options with a healthcare professional based on the current available therapies.

Summary

Frontal Fibrosing Alopecia is a relatively rare but distressing condition that primarily affects the hairline, eyebrows, and other facial hair. While it can be challenging to diagnose and manage, seeking early medical advice and exploring various treatment options can help individuals with FFA slow down its progression and potentially promote some hair regrowth.

Remember that everyone's experience with FFA is unique, and treatment outcomes can vary. Coping with hair loss, whether due to FFA or other conditions, involves not only physical but also emotional and psychological aspects. Seek support, care for your well-being, and explore treatment options with the guidance of a healthcare professional to best manage FFA and maintain your confidence and self-esteem.

References

  1. Miao Y, Jing J, Du XF, Mao MQ, Yang X, Zhong-Fa Lv. Frontal fibrosing alopecia: A review of disease pathogenesis. Frontiers in Medicine. 2022 Jul 25;9.
  2. Carmona‐Rodríguez M, Moro‐Bolado F, G. Romero-Aguilera, Ruiz‐Villaverde R, Carriel V. Frontal Fibrosing Alopecia: An Observational Single-Center Study of 306 Cases. Life [Internet]. 2023 Jun 8 [cited 2024 Jan 27];13(6):1344–4. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10300830/
  3. Frontal Fibrosing Alopecia patient information leaflet, Oxford University Hospitals, Dr Caroline Champagne, March 2015, Review March 2018 https://www.ouh.nhs.uk/patient-guide/leaflets/files/11753Palopecia.pdf
  4. Beyzaee AM, Goldust M, Patil A, Ghoreishi B, Ghahremanloo T, Rahmatpour Rokni G. Treatment of Frontal Fibrosing Alopecia. Al Mutairi N, editor. Dermatologic Therapy. 2023 Feb 16;2023:1–22.
  5. Semsarzadeh N, Khetarpal S. Platelet-Rich Plasma and Stem Cells for Hair Growth: A Review of the Literature. Aesthetic Surgery Journal. 2019 May 20;

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This content is purely informational and isn’t medical guidance. It shouldn’t replace professional medical counsel. Always consult your physician regarding treatment risks and benefits. See our editorial standards for more details.

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Kutal Mete Tekin

MRes, Bioengineering, Imperial College London

Kutal trained as a medical doctor in Istanbul before moving to London for this research masters at Imperial College London. He works as a part time medical interpreter with the NHS. His written work can also be seen in the motor sports sector as he has been a freelance sports writer and and editor since 2016.

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