All information is taken from the Alopecia UK website (with permission). For more help and advice on alopecia, visit the Alopecia UK.
What is frontal fibrosing alopecia (FFA)?
Frontal fibrosing alopecia (FFA) is a type of scarring hair loss that primarily affects the frontal scalp, including the forehead, eyebrows, and sideburn areas.
FFA most commonly affects post-menopausal women, though it can also occur in younger women and men. The number of people affected worldwide appears to be increasing.
What does frontal fibrosing alopecia look like?
FFA typically causes the hairline to recede (move back) across the forehead and sideburns. Key signs include:
- Smooth, pale, or shiny scalp where hair follicles are no longer present.
- Redness or scaling around remaining hair follicles at the edges of affected areas
- Loss of eyebrows, eyelashes or other body hair.
- Small skin-coloured bumps (known as papules) on the face where fine hairs are under attack. These are common in men with FFA.
- Some people with FFA may also experience Lichen Planus Pigmentosus, a condition resulting in oval-shaped brown or grey marks on the skin. This is more common in people with skin of colour.
While FFA often occurs without physical discomfort, some people experience:
- Itching
- Burning or tenderness along the frontal hairline
How is frontal fibrosing alopecia diagnosed?
In most cases the typical way FFA looks is enough for a dermatologist to make a diagnosis. This may include examination using a hand-held microscope (trichoscopy), to look at the skin up close. If there is uncertainty about the diagnosis, they may ask to take a small piece of skin (scalp biopsy) from the edge of an affected area.
Accurate diagnosis is important because FFA is a permanent form of hair loss and requires early intervention to preserve remaining hair.
Is frontal fibrosing alopecia permanent?
It is unlikely that hair will be able to regrow once the hair follicles have been destroyed. However, treatment may slow or stop further hair loss.
What causes frontal fibrosing alopecia?
While the exact cause of FFA is unknown, research shows that increased numbers of immune cells are found around the hair follicles in the affected skin of people with FFA. These immune cells are seen specifically in the upper regions of the hair follicle, an area which holds stem cells. These stem cells are important for regenerating the hair follicle through its phases of growth and rest. Destruction of the stem cells means the hair follicle is no longer able to regenerate. Scarring also forms in the affected areas. However, it is not yet fully understood why this happens.
- FFA sometimes affects more than one person in a family, and genetic studies have shown there can be an inherited predisposition to the disease.
- A European study suggested that FFA may be genetically similar to other inflammatory conditions like ankylosing spondylitis, birdshot uveitis, Behcet’s disease, and psoriasis.
- Another study showed that in some people with a variation in the CYP1B1 gene, oral contraceptive use may increase the risk for FFA. This gene is important for the body’s ability to process drugs, hormones and toxins.
- FFA was first described in 1994 and since then has become increasingly common across the world, suggesting that FFA could be triggered by environmental factors (influences from outside the body). Environmental factors may include ingredients in skin care cosmetics, but so far no relationship has been proven.
Can frontal fibrosing alopecia be treated?
Currently, there is no treatment that can reverse hair loss from FFA. Treatments focus on slowing progression by reducing immune system activity and protecting remaining hair follicles:
- Topical and intralesional corticosteroids
- Immunosuppressants
- Antibiotics
- Hydroxychloroquine
- Topical calcineurin inhibitors
Early intervention may improve outcomes, so it’s important to consult a dermatologist promptly if you notice symptoms.
Additional Information:
The British Association of Dermatologists have produced a patient information leaflet about Frontal Fibrosing Alopecia:
READ THE BAD PATIENT INFORMATION LEAFLET ON FFA
The Scarring Alopecia Foundation, SAF, have some detailed information:
