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Frontal Fibrosing Alopecia

What is Frontal Fibrosing Alopecia (FFA)?

Primarily found at the frontal region of the scalp, Frontal Fibrosing Alopecia (FFA) is a condition where there is hair loss and scarring first appearing at the margin of the scalp near the forehead, which progressively advances backwards creating an effect as if the entire hairline is moving backwards. This condition can also cause loss of eyebrow hair in association with hair loss on the scalp. This usually affects post-menopausal women over 50, but it can also occur in the 20’s or 30’s.

What is the cause of Frontal Fibrosing Alopecia (FFA)?

The cause of Fibrosing Alopecia (FFA) is unknown.

What are the symptoms?

Post-menopausal and other women suffering from FAA usually experience easy hair loss at the front and sides of the scalp with inflammation. Initially, the hairline looks fairly normal, but there is some redness and puffiness around individual hair follicles which upon close inspection can reveal the presence of pinpoint pustules. Burning, stinging, itching or irritation may also be present.

How is it diagnosed?

The doctor, usually a dermatologist, will examine this area and perform a skin biopsy from the affected area and on occasion from the eyebrow area as well.

What tests are needed?

A skin biopsy is the most common way to diagnose FFA. Yet, often this diagnosis can sometimes not be confirmed after a biopsy. Microscopically FFA and Lichen Planopilaris (LPP) have almost identical findings and are felt to be related.

What is the expected duration?

FFA can progress for months to years and in some cases 50% or more of the hair on the scalp can be lost and replaced with scar tissue.

How can it be prevented?

At this time there is not a method of the prevention of FFA.


Medications that are usually administered to treat FFA include a combination of topical and localized injections of steroids taken orally and oral Doxycycline and Hydroxchloroquine for anti-inflammatory purposes, and topical tacrolimus.

Recent clinical studies suggests that Platelet Rich Plasma (PRP) can help with symptomatic improvement and some hair growth for individuals with FFA, so this is a treatment option that can be considered as well

When to contact a professional

Contact a professional at the first sign of hair thinning, irritation or redness at the frontal margins of the scalp.


FFA is very stubborn to treat and can progress for years. Once the hair follicles are destroyed, the hair does not grow back and needs either stem cells or hair transplant surgery to provide new growth of hair.

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