Frontal Fibrosing Alopecia

Frontal fibrosing alopecia is a form of alopecia (hair loss) that affects the area where the hairline meets the front of the scalp.

It can also affect areas around the ears, and can cause hair loss from the eyebrows as well.

Believed to be a variant of lichen planopilaris, this condition causes hair loss when the affected hair follicles become inflamed and then destroyed.

Frontal fibrosing alopecia is a variant of lichen planopilaris that affects the area where the hairline meets the front of the scalp

Affected hair follicles become inflamed and then destroyed

Some patients may also report itching, burning or pain around the hairline

Treatment will depend on whether inflammation and redness are present and may involve topical corticosteroids, immunosuppressive drugs and hydroxychloroquine

What causes Frontal Fibrosing Alopecia?

While the exact cause is unknown, it is suspected that frontal fibrosing alopecia is caused by autoimmune activity.

Cells called lymphocytes are present in the body’s immune system, and when these attack the hair follicles, this results in hair loss.

While this is understood, what causes the condition to affect this particular part of the scalp is unknown, though some medical experts believe that hormones could play a role.

Who is at risk of Frontal Fibrosing Alopecia?

Women who have recently experienced menopause are commonly affected, something that supports the belief that hormonal changes are a cause. It affects women more often than men, but rare cases do occur. Patients already living with lichen planopilaris may also be at higher risk.

What are the symptoms of Frontal Fibrosing Alopecia?

The most obvious symptom of the condition is hair loss, which can be emotionally upsetting for those affected. Some patients may also report itching, burning or pain around the hairline, while others will experience no other symptoms at all.

Images of Frontal Fibrosing Alopecia

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How does a Dermatologist diagnose Frontal Fibrosing Alopecia?

A dermatologist may conduct a skin biopsy, which involves removing a small area of the affected skin to be examined under a microscope.

Carried out under a local anaesthetic, the procedure is relatively quick, and will result in a small scar. Once the diagnosis has been confirmed, the dermatologist will then consider different treatment options.

How does a Dermatologist treat Frontal Fibrosing Alopecia?

While treatment options exist, not all are successful, and some patients may not find a suitable treatment to help with their frontal fibrosing alopecia.

Your dermatologist may choose a treatment option based on the severity of the condition, and whether or not any irritation or inflammation is present.

If this is the case, the patient may be prescribed antibiotics to ease inflammation and redness.

Topical corticosteroids creams or gels may be used to treat the affected area alongisde other medications such as Tacrolimus.

This is an immunosuppressive drug that can calm the immune system in the affected area once applied. Steroids can also be injected into the skin, and this treatment will need to be repeated on a regular basis for it to be effective.

Other drugs that calm the immune system can also be used to slow or ease hair loss – a drug called Hydroxychloroquine, an anti-rheumatic drug, regulates the immune system’s activity.

Given that autoimmune tendencies may be the cause of frontal fibrosing alopecia, this medication may be able to treat it.

However, as Hydroxychloroquine poses a small risk of eyesight damage, prolonged use is not recommended, and patients using this treatment will be subject to annual eye examinations.

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