Hair loss types: Frontal fibrosing alopecia overview

Frontal fibrosing alopecia (early)

This type of hair loss often looks like a receding hairline that runs along the front and sides of your head.

Frontal fibrosing alopecia (FFA) tends to start slowly, often causing a thin band of balding skin that runs along the front and sides of the hairline.

FFA can also cause hair loss elsewhere on the body. Anywhere you have hair, you may notice hair loss. Many people lose some (or all) of their eyebrows. As the hair loss advances, some people lose pubic hair, underarm hair, or hair on their arms or legs. People with facial hair may notice less hair in their beard area.

Is frontal fibrosing alopecia rare?

When the first patients were diagnosed with this type of hair loss in the 1990s, FFA was considered rare.

Today, the number of people being diagnosed with FFA is growing rapidly. People around the world develop FFA. Most are women; however, men have also been diagnosed with FFA.

At what age does frontal fibrosing alopecia start?

FFA is usually diagnosed in women after menopause (have not had a period for at least one year). Most notice hair loss about two to 12 years after they start menopause.

FFA can also be diagnosed earlier in life. This may be most common in Black women. In a small study of Black American women who had FFA, the ages of the women ranged from 28 to 85 years old. About half of these Black American women were not in menopause when they were diagnosed with FFA.

Because this was a small study, more research is needed to know whether Black American women are more likely to see signs of FFA before they reach menopause.

How fast does frontal fibrosing alopecia progress?

FFA tends to develop slowly. The first sign of FFA that you may see is often noticeable loss of eyebrow hairs. Between 80% and 95% of women diagnosed with FFA have lost some (or all) of their eyebrows.

It’s also possible for FFA to cause hair loss that comes on rapidly rather than gradually. Some people develop patches of hair loss rather than a slowly receding hairline.

How long does frontal fibrosing last?

Without medical treatment, FFA often causes permanent hair loss that covers a larger area with each passing year. That receding hairline that was once barely noticeable can become a bald band, which reaches to the middle of the head — or even further back. For some people, FFA does stop after so many years. However, it’s not possible to know which patients will experience this. That’s why dermatologists recommend treatment.

Can frontal fibrosing alopecia be reversed?

If you catch FFA early and treat it, you may regrow some hair. As FFA progresses, the hair follicles (openings from which hair grows) scar over. Once a hair follicle scars, it can no longer grow hair. That’s why the American Academy of Dermatology recommends seeing a board-certified dermatologist when you first start experiencing hair loss.

Can frontal fibrosing alopecia be stopped?

Caught early, medical treatment can stop further hair loss. The earlier someone is diagnosed with FFA and starts treatment, the more effective treatment tends to be.

As FFA often develops slowly, it can be difficult to notice the earliest signs.

You’ll find more information about the possible signs and symptoms along with pictures of FFA at: Frontal fibrosing alopecia: Signs and symptoms.

Image
Image used with permission of the Journal of the American Academy of Dermatology. (J Am Acad Dermatol 2005;52:55-60.)

References
Brandi N, Starace M, et al. “The doll hairline: A clue for the diagnosis of frontal fibrosing alopecia.” J Am Acad Dermatol. 2017;77(5):e127-8.

Callender VD, Reid SD, et al. “Diagnostic clues to frontal fibrosing alopecia in patients of African descent. J Clin Aesthet Dermatol. 2016;9(4):45-51.

Fertig R, Tosti A. “Frontal fibrosing alopecia treatment options. Intractable Rare Dis Res. 2016;5(4):314-5.

Imhof R, Tolkachjov SN. “Optimal management of frontal fibrosing alopecia: A practical guide.” Clin Cosmet Investig Dermatol. 2020;13:897-910.

Mirmirani P, Tosti A, et al. “Frontal fibrosing alopecia: An emerging epidemic.” Skin Appendage Disord 2019;5:90-3.

Tosti A, Piraccini BM, et al. “Frontal fibrosing alopecia in postmenopausal women.” J Am Acad Dermatol. 2005;52:55-60.

Strazzulla LC, Avila L, et al. “Prognosis, treatment, and disease outcomes in frontal fibrosing alopecia: A retrospective review of 92 cases.” [research letter] J Am Acad Dermatol. 2018;78:203-4.

Vano-Galvan S, Molina-Ruiz AM, et al. “Frontal fibrosing alopecia: A multicenter review of 355 patients.” J Am Acad Dermatol. 2014;70:670–8.

Written by:
Paula Ludmann, MS

Reviewed by:
Shani Francis, MD, MBA, FAAD
William W. Kwan, MD, FAAD

Last updated: 8/3/22

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