Frontal fibrosing alopecia

What is frontal fibrosing alopecia?

Frontal fibrosing alopecia is a type of scarring alopecia characterised by a progressive, symmetrical and well-defined recession of the hairline along the forehead and temples. As it is a scarring alopecia, the lost hair does not regrow, making it crucial to seek medical advice at the first signs of eyebrow loss or frontal hairline recession, so that treatment can be started as early as possible.

It is currently one of the most common forms of scarring alopecia whose incidence has increased significantly in recent decades, particularly among postmenopausal women, although it may also affect premenopausal women and, more rarely, men. 

Signs and symptoms of frontal fibrosing alopecia

The signs of frontal fibrosing alopecia include progressive, symmetrical recession of the frontal hairline. Partial or complete eyebrow loss is common and, in many cases, may be the first sign of the disease, even before it affects the scalp. 

As the condition progresses, areas of alopecia may appear behind the ears or in other facial and body regions. Hair loss is often accompanied by symptoms such as itching (pruritus) or a sensation of burning or tightness. 

Causes of frontal fibrosing alopecia

Although its exact cause is unknown, several hypotheses have been proposed without being conclusively confirmed. These include hormonal factors, immune system disturbances, the potential role of endocrine disruptors—whether through exposure to certain cosmetics or sunscreens—as well as environmental pollution. 

Diagnosis of frontal fibrosing alopecia

Trichoscopy is essential for diagnosis, as it can identify possible signs of inflammation and follicular damage, including:

• Absence of follicular openings.
• Accumulation of keratin and inflammatory cells around the follicles.
• Vascular changes in the perifollicular area.
• Follicular inactivity.

Treatment of frontal fibrosing alopecia

Treatment aims to reduce inflammation and stabilise the disease through: 

• Topical or injectable anti-inflammatory therapies to modulate the immune response. 
• Topical treatments or medications (e.g., minoxidil) to improve hair thickness and density in unaffected areas. 
• Topical and oral antiandrogens.