Frontal Fibrosing Alopecia

Hair loss is a normal physiological process that occurs as you get older. This is primarily due to the hair follicles getting fragile as you age. But this can be daunting if it happens at an early age. Losing hair can devastate your physical and mental well-being and overall appearance. There are several types of hair loss affecting both men and women. This blog post will explore a type of hair loss known as "Frontal Fibrosing Alopecia." This condition is common among women and appears after menopause. It is characterized by hair loss on the front and sides of your scalp. Hair loss may also occur on eyebrows, eyelashes, and other body parts. An autoimmune reaction, genetics, or hormones may cause frontal fibrosing alopecia (FFA).  

Hair loss due to FFA is permanent and cannot be reversed. However, medications can help control the condition. Read more about causes, symptoms, diagnosis, and treatment.  

What is Frontal Fibrosing Alopecia?

Frontal fibrosing alopecia, or FFA, is a condition that causes hair loss (alopecia) on the front and sides of the scalp. It may also affect hair in other parts of the body, but it can commonly affect eyebrows as well. This leads to permanent hair loss and usually worsens over time.  

Who Might Develop Frontal Fibrosing Alopecia?

Frontal fibrosing alopecia most often affects women after menopause, commonly after the age of 50. However, women as young as in their 20s may also develop it. Men rarely have frontal fibrosing alopecia.  

You may be at a higher risk of developing FFA, if you have: 

• A family history
• Type 2 diabetes
• Thyroid disease 
• Rosacea  

What Causes Frontal Fibrosing Alopecia?

The exact cause of frontal fibrosing alopecia is not known, but researchers believe it could be due to the following: 

Autoimmune Reaction

• Your immune system mistakenly attacks your healthy hair follicles, as in conditions like lichen planus.
• This leads to a series of inflammatory reactions in the body, causing hair loss and scarring. 

Genetics 

• Having an abnormal genetic mutation that has been passed on from generation. 

Hormonal Fluctuations

• Hormone imbalance, especially post-menopause, may weaken the hair follicles, resulting in hair loss. 

Certain Surgeries

• It could be due to adverse or side effects of aesthetic procedures like facelifts or hair transplants. 

Environmental Factors

• Increased exposure to sunlight
• Infections from viruses
• Certain medications
• Pollutants in food
• Sunscreens  

What Are the Symptoms of Frontal Fibrosing Alopecia?

The most striking symptom or characteristic feature of frontal fibrosing alopecia is hair loss along the front and sides of your hairline. The hair loss may begin slowly but can worsen over time. Your skin around the hair loss can appear pale, scarred, or shiny.  

Other symptoms of frontal fibrosing alopecia include: 

• Eyebrow loss (affects 80 to 90% of women with FFA)
• Flat, dark brown, or gray areas of the skin on your face and neck 
• Itchy skin (pruritus)
• Pain on your scalp
• Large veins on your forehead
• Rosacea 
• Tiny yellow or skin-colored bumps that appear as pimples near your hairline or on your face or scalp
• Hair loss from arms, legs, face, and pubic region  

How is Frontal Fibrosing Alopecia Diagnosed?

Consult a dermatologist (a doctor specializing in diagnosing and treating conditions related to the skin, hair, and nails) if you notice hair loss near your scalp. Your doctor can diagnose the condition through the following: 

• Recording medical history to assess if you suffer from any debilitating disease like diabetes, hypertension, or thyroid problems.
• Evaluating the medications being taken. 
• Assessing your symptoms about when you first noticed hair loss and what body parts your hair loss occurred.
• Physically examine your hairline, scalp, and eyebrows.  

Your doctor may recommend the following tests to confirm the diagnosis of FFA and rule out other hair loss conditions like traction and androgenic alopecia:

• Biopsy: Your doctor will numb your scalp area and remove a piece of skin. This will be examined under a microscope. 
• Hair pull test: Your doctor will pull your hair to check how many fall out. 

How is Frontal Fibrosing Alopecia Treated?

Several FFA treatments are available, but the research supporting their clinical effectiveness is limited. Thus, doctors often combine more than one type of treatment.  

Treatment options include: 

Topical Agents 

• This first-line therapy includes medicated gels, lotions, or creams applied directly to the affected area of your scalp. 
• Your doctor may use topical corticosteroids or calcineurin inhibitors to manage scalp inflammation and other symptoms.  

Steroid Injections

• Your doctor may recommend steroid injections in the form of intralesional steroids.
• Steroid injections are linked to a positive outcome 88% of the time.  

Anti-inflammatory Medications

• Oral Anti-inflammatory medications, such as anti-malarial drugs (hydroxychloroquine) and antibiotics (doxycycline), are used to target inflammation linked to FFA.  

5-alpha Reductase Inhibitors

• Your doctor may recommend 5-alpha reductase inhibitors to reduce androgens (a group of sex hormones that include testosterone). 
• These include finasteride and dutasteride, which are used to treat prostate disorders and help stop the progression of hair loss in 88% of cases.  

Other Medications 

• If the above treatments don't help, your doctor may recommend the following medications. 
• Oral Immunosuppressive Drugs 
• Methotrexate
• Prednisone 
• Peroxisome Proliferator-activated Receptor-gamma (PPAR) Agonists
• Retinoids
• Naltrexone  

Other Treatment Options 

• Your doctor can recommend a hair transplant to restore your lost hair.
• Other aesthetic options to camouflage hair loss include:
• Hair wigs 
• Hairpieces 
• Hats 
• Hair Bands 
• Scarves  

Final Note 

Frontal fibrosing alopecia (FFA) is a condition that results in hair loss around the front and sides of your scalp. You may also notice hair loss on your eyebrows, eyelashes, and other body parts. FFA mostly affects women after the age of 50 post-menopause, and men are rarely affected. The exact cause of FFA is unknown, but it is believed to develop due to an autoimmune reaction, genetics, or hormonal fluctuations. Your doctor may diagnose FFA with a physical examination and a skin biopsy to design a suitable treatment plan for you. Doctors usually suggest a combination of medications to treat this condition. Though hair loss due to FFA is permanent, early diagnosis and treatment can help slow its progress.