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Frontal Fibrosing Alopecia

Progressive cicatricial alopecia primarily affecting postmenopausal women with characteristic recession of the frontotemporal hairline.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Dermatoloji department. Book Appointment →

What is Frontal Fibrosing Alopecia?

Frontal fibrosing alopecia (FFA) is considered a clinical variant of lichen planopilaris (LPP) and represents a primary lymphocytic cicatricial alopecia. It predominantly affects postmenopausal women (mean age 60s) but can occur in men and premenopausal women. Incidence has increased dramatically since the 1990s, suggesting environmental and hormonal triggers.

Pathogenesis involves T-cell-mediated autoimmune destruction of follicular stem cells in the bulge region, leading to permanent hair loss with fibrotic replacement. Postulated triggers include sunscreen ingredients, leave-on cosmetic products, hormonal changes (menopause), thyroid autoimmunity and genetic susceptibility (HLA, environment).

Clinical features include band-like recession of frontal-temporal hairline (often 1-8 cm), eyebrow loss (50-80%), facial papules, perifollicular erythema and scaling, depressed veins on forehead, and possible loss of eyelashes, body hair and pubic hair. Trichoscopy shows perifollicular erythema, lonely hairs and tubular casts. Biopsy confirms lymphocytic infiltrate with fibrosis. Treatment includes topical/intralesional steroids, topical tacrolimus, oral 5-alpha reductase inhibitors (finasteride, dutasteride), hydroxychloroquine, doxycycline, JAK inhibitors and avoidance of trigger products.

Symptoms

Band-like recession of frontotemporal hairline
Eyebrow thinning or complete loss (50-80%)
Facial papules (small skin-colored bumps)
Perifollicular erythema and scaling
Lonely hairs in alopecic band
Depressed veins on forehead
Eyelash, body and pubic hair loss
Pruritus, burning or tenderness in scalp

Risk Factors

Postmenopausal status (most common)
Female sex (>90% of cases)
Genetic predisposition (HLA-B*07:02)
Hormonal changes (menopause, hysterectomy)
Thyroid autoimmunity (Hashimoto)
Sunscreen and leave-on cosmetic products (proposed)
Family history of FFA or LPP
Other autoimmune diseases

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Progressive frontal hairline recession
  • Eyebrow thinning or loss
  • Symptomatic scalp (itching, burning, scaling)
  • Facial papules with hairline recession
  • Family history of FFA or scarring alopecia
  • Failure to respond to standard alopecia treatments
  • Concurrent autoimmune disease with hair loss
  • Concerns about progression and cosmetic impact

Treatment Methods

01
Topical clobetasol or other potent corticosteroid
02
Intralesional triamcinolone (2.5-5 mg/mL) into active areas
03
Topical tacrolimus 0.1% as steroid-sparing agent
04
Oral finasteride 2.5-5 mg/day or dutasteride 0.5 mg/day
05
Hydroxychloroquine 200-400 mg/day for inflammation control
06
Doxycycline 100-200 mg/day as antiinflammatory
07
JAK inhibitors (tofacitinib, baricitinib) in refractory cases
08
Avoidance of suspected trigger products and sun protection

Which Department to Visit?

You can visit our Dermatoloji department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.