Frontal fibrosing alopecia

A guide to understanding frontal fibrosing alopecia

Frontal fibrosing alopecia belongs to the group of primary cicatricial alopecias, a category of hair disorders in which the hair follicle is progressively destroyed and replaced by scar tissue, making hair regrowth impossible in the affected areas.

It is an increasingly common form of alopecia whose exact cause has not yet been fully defined. It most frequently affects women after menopause, although its incidence has been rising in recent years among premenopausal women and, less commonly, in men.

The Hair Disorders Unit at Grupo Pedro Jaén leads and participates in several research studies on frontal fibrosing alopecia and has published some of the most relevant scientific data currently available on this increasingly prevalent condition.

Frontal fibrosing alopecia is characterised by hair loss along the frontotemporal hairline, commonly referred to as the “headband” area.

In addition to scalp involvement, hair loss associated with this condition may also affect other hair-bearing areas of the body, such as the eyebrows, eyelashes and sideburns.

In fact, loss of the sideburns is considered a particularly characteristic clinical sign of frontal fibrosing alopecia. This hair loss usually appears bilaterally and in a largely symmetrical pattern. In some patients it results in a clearly defined area of complete hair loss with smooth skin, while in others it presents as a more subtle, diffuse reduction in hair density.

Beyond hair loss, frontal fibrosing alopecia may be accompanied by scalp itching or pain. It is also relatively common for patients to develop facial papules (small bumps on the face) and for the frontal veins to become more prominent.

Taken together, these features—along with the progressive recession of the frontal hairline—can lead to a significant aesthetic impact on the face, particularly in female patients.

Causes of frontal fibrosing alopecia

For reasons that are still under investigation, the incidence of frontal fibrosing alopecia has increased progressively in recent years.

According to studies published to date, including several led by specialists from the Hair Disorders Unit at Grupo Pedro Jaén, the development of this condition involves a combination of hormonal and autoimmune mechanisms that trigger inflammation and subsequent destruction of the hair follicle in genetically predisposed individuals.

On the one hand, an autoimmune reaction has been identified in which the body’s immune system targets the hair follicle, inducing an inflammatory process that, if not treated early, ultimately leads to follicular destruction and permanent hair loss.

On the other hand, evidence supporting a hormonal component is based on the higher prevalence of frontal fibrosing alopecia in women around the time of menopause.

Finally, recent research has demonstrated a degree of genetic susceptibility. According to published data, approximately 10% of patients with frontal fibrosing alopecia have at least one affected family member.

Diagnosis of frontal fibrosing alopecia

The diagnosis of frontal fibrosing alopecia is established during a clinical consultation through a detailed review of the patient’s medical history and a physical examination. This assessment is complemented by digital trichoscopy, which provides a highly detailed evaluation of the scalp and hair shafts using a digital microscope.

The clinical pattern of this condition is often so characteristic that a diagnosis can be made without further tests. However, in selected cases, a histological analysis may be required to assess the degree of inflammation or to clarify diagnostic uncertainty. This involves performing a scalp biopsy, a simple outpatient procedure that takes less than 15 minutes under local anaesthesia and requires only a single suture after the sample is obtained.

In addition, a comprehensive thyroid function assessment is recommended, as this form of cicatricial alopecia may be associated with thyroid disorders, particularly autoimmune hypothyroidism.

In this context, specialists at the Hair Disorders Unit at Grupo Pedro Jaén emphasise the importance of early diagnosis and prompt initiation of medical treatment, since in cicatricial alopecias such as frontal fibrosing alopecia, hair loss is irreversible once scar tissue has formed and the hair follicle is permanently destroyed.

“Once hair has been lost in a specific area, cosmetic measures are required, as regrowth does not occur”

Treatment of frontal fibrosing alopecia in women and men

Because frontal fibrosing alopecia is a scarring alopecia, it has traditionally been considered a condition without treatment. However, although there is currently no curative therapy for this form of alopecia, several therapeutic options are available that allow for a more optimistic outlook. By combining different treatment strategies, it is often possible to stabilise hair loss and, in some cases, achieve limited regrowth at the hairline.

In general terms, current treatments for frontal fibrosing alopecia are aimed at preserving existing hair and controlling the inflammatory mechanisms responsible for follicular destruction until the disease becomes inactive spontaneously

In all cases, treatment must be highly individualised, taking into account the extent of hair loss and the degree of scalp inflammation. The main therapeutic approach is based on combining anti-androgenic agents and corticosteroids.

Cosmetic measures

The primary objective of medical treatment in frontal fibrosing alopecia is to stabilise and slow hair loss; however, it does not usually result in visible regrowth. When hair loss has already occurred in a specific area, and regrowth is not possible, cosmetic measures become necessary. These may include scalp micropigmentation, eyebrow microblading, or hair prostheses, depending on the affected area and the patient’s needs.

Photoprotection and frontal fibrosing alopecia

In recent years, several studies have explored a possible association between the use of certain sunscreen filters and frontal fibrosing alopecia. This remains a controversial topic under active investigation, and at present there is insufficient evidence to recommend avoidance of sunscreen products.

More information

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