Frontal Fibrosing Alopecia

Understanding Frontal Fibrosing Alopecia

Frontal fibrosing alopecia, commonly known as FFA, is a form of scarring alopecia that primarily affects the frontal hairline.

Inflammation develops around susceptible hair follicles and can progressively damage and destroy them. Once a follicle has been completely destroyed and replaced by scar tissue, hair cannot naturally regrow from that follicle.

For this reason, early recognition and appropriate management are particularly important.

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What Does FFA Look Like?

FFA typically causes the frontal hairline to move gradually backwards.

It can also affect:

• The temples
• Hair around the ears
• Eyebrows
• Occasionally hair elsewhere on the body

The affected hairline may become progressively smoother and paler as follicles are lost. Some patients also develop redness or scaling around remaining hairs close to the active edge of the condition.

The speed of progression varies considerably between individuals.

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Symptoms of Frontal Fibrosing Alopecia

FFA does not always cause physical symptoms.

When symptoms are present, patients may experience:

• Itching
• Tenderness
• Burning
• Scalp sensitivity
• Redness around individual follicles
• Scaling around hairs near the hairline

Loss of eyebrow hair can sometimes occur before or alongside obvious recession of the scalp hairline.

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Who Can Develop FFA?

FFA is most frequently recognised in women after the menopause, but it can also occur in premenopausal women, men and people from different ethnic backgrounds.

Its precise cause remains uncertain.

It is believed to involve an immune-mediated inflammatory process affecting the hair follicle and is considered closely related to lichen planopilaris. Genetic, immune and hormonal factors may all have a role.

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Assessment and Diagnosis

Receding hairlines are common and are not always caused by FFA.

A careful assessment is therefore important to distinguish FFA from pattern hair loss, traction alopecia and other causes of frontal recession.

Assessment may consider:

• The shape and pattern of recession
• Changes to the eyebrows
• Symptoms such as itching or burning
• Redness and scale around follicles
• Loss of visible follicular openings
• Medical history
• Progression over time

Digital trichoscopy can help examine affected areas more closely.

Where FFA or another scarring alopecia is suspected, dermatological assessment and sometimes scalp biopsy may be required to establish or confirm the diagnosis.

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Treatment Focuses on Preserving Hair

The primary objective in active FFA is generally to reduce inflammation and slow or halt further follicular loss.

Treatment cannot reliably restore hair from follicles that have already been completely destroyed by scarring.

The appropriate medical management varies between patients and may require specialist dermatological care.

YT Medical can support assessment and ongoing hair-loss planning, while recommending onward referral where treatment falls outside the clinic’s appropriate scope.

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Can Hair Transplantation Be Considered?

Hair transplantation is not usually the first consideration when FFA remains active.

Because the underlying inflammatory condition may continue or reactivate, any surgical restoration needs particularly careful assessment and should generally only be considered when the disease has been appropriately managed and demonstrated sustained stability.

Patients interested in restoring permanently affected areas can discuss the available options once the condition has been fully assessed.