Frontal Fibrosing Alopecia (FFA): Causes, Treatment, and Diet

Frontal fibrosing alopecia (FFA) causes hair loss at the front and sides of your scalp. While there’s no way to reverse hair loss from FFA, you can control it with medication.

Frontal fibrosing alopecia (FFA) causes hair loss and scarring at the hairline, where your hair meets your forehead and temples.

It typically affects people who are assigned female at birth and appears after menopause. Keep reading to learn more about symptoms, diagnosis, and treatment.

The main symptom of FFA is a band of hair loss along the front and sides of the head, where your hair starts. Some people also lose their eyebrows, along with hair on their face, arms, legs, or pubic area.

You might notice scarring in the areas where your hair once was. You might also notice a red, dry, or itchy scalp where you still have hair follicles. Some people experience raised bumps on their face that resemble pimples.

With FFA, hair loss is progressive and permanent. In other words, the bald area grows slowly over time, and the hair doesn’t return.

It’s not clear what causes FFA. According to 2022 research, it tends to run in families and may have a genetic component.

Hormones could also play a role. FFA mostly affects people who were assigned female at birth following the onset of menopause.

FFA likely develops in genetically predisposed people who also experience other environmental triggers.

A 2021 study in Brazil recruited 451 people with FFA and 451 control participants. All participants completed a questionnaire assessing various environmental factors, including diet, hair and skin care routines, and allergies.

The researchers reported a link between FFA and the use of facial cleansers, moisturizers, and formaldehyde-based hair straightening products. But while these results may hint at environmental factors involved in FFA, more research is needed to determine a causal link.

Anyone can get FFA. But it’s more common among people assigned female at birth who have experienced menopause.

A 2018 review suggests that FFA appears at around age 56 on average. But because FFA progresses slowly, many people don’t receive a diagnosis until several years later.

It’s not clear how many people have FFA. While cases have been increasing for the past 2 decades, experts still consider it rare.

If you notice hair loss that resembles FFA, a doctor or healthcare professional might refer you to a skin and hair specialist called a dermatologist.

Dermatologists use several tools and techniques to identify FFA. They might start by asking you questions about your general health and proceed with questions about your symptoms, including when you first noticed them.

A dermatologist will physically examine parts of your body where you’re experiencing hair loss. If they suspect FFA, they may suggest a minimally invasive procedure called a biopsy, which involves taking a small skin sample from your scalp. You’ll receive a local anesthetic during the procedure.

A biopsy can provide more information about the type of hair loss you’re experiencing. The dermatologist can use it to confirm an FFA diagnosis.

There are few guidelines for the treatment of FFA. While several FFA treatments are available, research into their clinical effectiveness is limited. And most people with FFA require more than one type of treatment.

You’ll likely need to work with a dermatologist to find the best combination of treatments for your FFA.

Topical agents

Topical agents include medicated creams or lotions that you apply directly to the affected area of your scalp. They’re a first-line therapy, but people almost always use them alongside other treatments to improve effectiveness.

A dermatologist will typically recommend topical corticosteroids to help reduce scalp inflammation and other FFA symptoms.

They may also recommend a calcineurin inhibitor. These aren’t common in treating FFA, but they may help with symptoms such as inflammation and scarring.

Steroid injections

A dermatologist might recommend a local steroid injection, also known as intralesional steroids.

According to a 2019 review of medical treatments for 622 people with FFA, steroid injections were linked to a positive outcome 88% of the time. In some cases, hair loss stabilized after a series of injections.

Anti-inflammatory medication

Oral anti-inflammatory medication for FFA includes the anti-malarial drug hydroxychloroquine and the antibiotic doxycycline. Both can help target inflammation linked to FFA in cases when localized treatments don’t work. They also carry a relatively low risk of side effects.

5-alpha reductase inhibitors

A dermatologist may also recommend 5-alpha reductase inhibitors. These medications reduce androgens, a group of reproductive hormones that include testosterone. They include finasteride and dutasteride, two drugs doctors typically use to treat prostate disorders.

The 2019 review cited above reveals that 5-alpha reductase inhibitors stopped the progression of hair loss in 88% of cases.

Other medications

If the treatments above don’t work, a doctor might suggest another medication.

Research into treatments for FFA is ongoing. More studies are needed to understand whether the following drugs can help with FFA:

  • Immunosuppressive drugs: Oral immune system-suppressing drugs, such as methotrexate, mycophenolate mofetil, and prednisone, have shown mixed effectiveness in treating FFA and carry a risk of side effects.
  • Peroxisome proliferator-activated receptor-gamma (PPAR) agonists: These drugs have shown promise in preventing hair loss in a few cases of FFA. More robust studies are needed to determine their effectiveness.
  • Retinoids: A small 2017 retrospective study suggests that retinoids, such as isotretinoin and acitretin, may stabili
    ze hair loss associated with FFA. But more research is needed.
  • Naltrexone: Naltrexone can help treat substance use disorders, but it may also help treat autoimmune disorders.

Hair transplantation and other aesthetic treatments

The treatments listed above work to stop hair loss from progressing. They can’t restore hair that you’ve already lost.

For this reason, many people with FFA look for additional treatments to reduce the appearance of hair loss. Hair transplants can occasionally help restore your hairline’s appearance if your FFA is stable. But the results don’t always last.

Other options to deal with hair loss include:

  • wigs
  • hairpieces
  • hats
  • hairbands
  • scarves

For eyebrow hair loss, some people opt for makeup or tattoos.

Diet and lifestyle changes

It’s not clear whether diet and lifestyle changes can help with FFA. To date, there are no clear indications that either eating or avoiding certain foods can stop hair loss. A dermatologist might suggest avoiding or adopting certain skin care or hair products.

Ongoing research suggests that FFA develops in people who have a certain genetic makeup and exposure to certain environmental factors. So, it’s not clear whether it’s possible to prevent FFA.

FFA is a type of hair loss that appears along your hairline. It typically affects people who were assigned female at birth after menopause, but it can affect anyone.

The causes of FFA aren’t yet clear, and research into treatments is ongoing. Consult a dermatologist to learn more about treatment options.

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