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Frontal Fibrosing Alopecia: A Complicated Skin Condition That Hinders Hair Growth

Get to know frontal fibrosing alopecia, a rare but progressing condition that can cause hair loss on the front of your scalp. The frontal fibrosing alopecia is also referred to as lichen planopilaris or LPP. It is a type of scarring alopecia which means it destroys the hair follicles and prevents them from growing back. Although this skin condition may be commonly confused with male pattern baldness, there are some major differences between these two conditions. The article below explains what you need to know about this complicated skin condition.

What Is Frontal Fibrosing Alopecia?

In simple terms, frontal fibrosing alopecia (FFA) is a type of scarring alopecia where hair growth is impeded. This is a rare condition that is estimated to affect fewer than 1% of the population. It typically affects adults between the ages of 30 and 50 years. Although it is less common than androgenetic alopecia and telogen effluvium (TE), it is more likely to recur which means it may be more challenging to treat. The cause of frontal fibrosing alopecia is unknown. There is some evidence to suggest that it is related to an auto-immune response, hormones or genetics may play a role. Other theories point to specific bacteria and fungi that cause the condition. There is still a lot to learn about this condition and more studies are needed to fully understand its progression.

The Difference between Fpp and Hair Loss Due to Male Pattern Baldness

These two conditions are quite different, but they are often confused with one another. Male pattern baldness is a progressive condition that can affect men and women that causes hair follicles to shrink and become smaller. On the other hand, FFA can cause hair follicles to stop growing completely.

This means that hair loss is not a gradual process. There is not much information available to determine the rate of progression of this condition. It can, therefore, be difficult to determine when the hair follicles will grow again. That is why FFA and androgenetic alopecia are often confused with one another. You can tell these two conditions apart based on the affected areas of your scalp.

When women begin to experience hair loss, they typically experience thinning along the top of their heads. This thinning is usually uniform and not as sudden as it is in men. Men, on the other hand, experience hair loss at the front and top of their heads. The hair along the sides of their heads and the back of their heads remain intact.

However, frontal fibrosing alopecia causes hair loss on the front of the scalp. The sides and the back of the scalp remain unaffected. The eyebrows and eyelashes can experience thinning of hair and the forehead skin may appear more pale and shiny.

How Do You Know If You Have Frontal Fibrosing Alopecia?

It can be difficult to diagnose FFA because the symptoms can be similar to other conditions, such as TE and androgenetic alopecia. One way to tell if you have FFA is by looking at the pattern of your hair loss. If the hair loss is all concentrated on the front, then it can be FFA. If the hair loss is distributed across the entire scalp, then it is likely to be another type of alopecia.

Another way to tell if you have FFA is if you have symptoms, such as pain in the scalp, inflammation, warmth, and/or itching. The symptoms for FFA are the same as for any type of alopecia areata. It can, therefore, be difficult to tell what type of alopecia you have. A dermatologist will be able to tell you whether or not you have FFA which typically requires a biopsy to confirm this diagnosis.

How to Treat Frontal Fibrosing Alopecia?

Unfortunately, there is no cure for FFA. That being said, there are treatment options that can help improve the symptoms and prevent further progression of the condition. Treatment options for FFA include the following: – Steroids – These are used to treat inflammation and itching. They do not promote hair growth.

This medication can be injected by the doctor or be prescribed as a topical cream – Finasteride or dutasteride – These medications are typically prescribed for androgenetic alopecia but have been demonstrated in some studies to prevent further hair loss and in some to regrow hair – Low-Level Laser Therapy – This is a treatment used to promote hair growth and in small studies have demonstrated a reduction of inflammation, the disappearance of symptoms, and evident hair regrowth with no side effects.

However, discontinuation of the treatment led to hair loss. – Minoxidil – This is a very common medication available over the counter that promotes hair growth. It can be applied topically or by prescription as a daily tablet. Minoxidil monotherapy is likely to be of little benefit to FFA, but when used in combination with finasteride or dutasteride and/or steroids it has shown some promising results. Hair Transplants this is a surgical procedure where hair from the back of the head is transplanted to the front of the scalp. Most FFA patients who undergo hair transplantation have been shown to lose the hair grafts in around four years.


Frontal fibrosing alopecia is a scarring alopecia that causes hair loss on the front of the scalp. It is less common than androgenetic alopecia but more likely to recur. It is a challenging condition to treat and often difficult to diagnose due to the symptoms being similar to other types of alopecia. Treatment options for FFA include injection or topical steroids, Low-Level Laser Therapy, finasteride or dutasteride, combination minoxidil therapy, and rarely hair transplants. For any patient that I see in my Freehold, New Jersey office with an atypical hair loss pattern I almost always recommend at minimum a scalp biopsy and possible referral to a dermatologist.

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