lichen planopilaris causing inflammation in the hairline

What is Frontal Fibrosing Alopecia?

In 1994, Professor Steven Kossard, a clinical dermatologist, first described frontal and temporal hair loss (with scarring) as Frontal Fibrosing Alopecia (FFA). It is identified by a band-like hair loss that can also affect eyebrows and other facial hair which is medically known as Cicatricial Alopecia.

This form of hair loss is slowly progressive which sees the whole hairline gradually recede. This is different from male pattern baldness because with FFA the hairline recedes in a linear pattern. Whereas, in pattern hair loss the hairline recedes in an “M” shape.


  1. What Causes Frontal Fibrosing Alopecia?
  2. What Are the Symptoms?
  3. How Do You Treat Frontal Fibrosing Alopecia?
  4. Conclusion

What Causes Frontal Fibrosing Alopecia?

Hormones, genetics and autoimmune diseases are all mentioned as causes of Frontal Fibrosing Alopecia, however, the cause is not yet fully understood. In most cases 1 of these factors is diagnosed as the cause, however, a combination of the 3 is also possible.

Studies have suggested that mainly post-menopausal women get FFA which has been the main indicator for it being hormonal based. However, it’s frequently reported in both men and women with autoimmune diseases. Autoimmune diseases include rheumatoid arthritis, thyroid disease and lupus.

Furthermore, clinical studies blame an inflammatory autoimmune reaction for frontal and temporal hair loss. Additionally, there is substantial evidence that FFA existed way before Kossard’s discovery since artistic portraits from the 15th and 16th centuries often show a fashionable frontal hairline. Although there are suggestions that this is from Traction Alopecia rather than FFA.

How is FFA related to Lichen Planopilaris (LPP)?

Frontal Fibrosing Alopecia is a form of Lichen Planopilaris. Other names for it include follicular lichen planus, Axel Munthe’s Syndrome and Kossard’s disease. According to the Genetic and Rare Diseases Information Center, there are 3 types of LPP; the classic Lichen Planopilaris, FFA, and Lassueur Graham-Little Piccardi Syndrome.

The cause of LPP is unknown, however, it’s thought to be caused by an autoimmune disease. The main signs and symptoms of this medical condition are tiny red bumps around your hair follicles that can cause itchiness, pain and a burning sensation. Later resulting in a permanent loss of hairs.

Follicular Lichen Planopilaris causes scarring which leads to permanent hair loss along the frontal hairline. Thus, a lichen planopilaris scalp infection leads to Frontal Fibrosing Alopecia.

A woman with band like hair loss caused by frontal fibrsing alopecia

Is this condition rare?

Frontal Fibrosing Alopecia is a rare condition, however, the number of known cases is increasing. The average age that women start to experience symptoms is 64 however it’s also been recorded in premenopausal women. Thus, the condition is also known as Postmenopausal Lichen Planopilaris (PLPP).

FFA is rarely seen in men. However, when genetic factors are involved then it’s more commonly seen in men.

The symptoms of FFA cause significant psychological distress and social anxiety which warrants further research into the cause and treatment of this type of scarring hair loss.

What Are the Symptoms?

The signs and symptoms of Frontal Fibrosing Alopecia last for a few years, whereby the loss of hair is slowly progressive. Symptoms only present in the frontal and temporal hairline which gradually turns bald with scarring alopecia. After a few years, the condition spontaneously stabilises, however, hair growth cannot naturally return.

The symptoms include:

  • Hairloss in a band-like pattern along the forehead and temples
  • Lonely hairs within the affected area
  • Ocassionally it speads to other parts of the body, including loss of eyebrows and eyelashes
  • Scarred skin after total hair loss in this area

How do you know if you have frontal fibrosing alopecia?

Perifollicular inflammation occurs along the hairline which affects the growth of your hair. As the number of hair follicles decreases, they are replaced with fibrosis. You will know if you have FFA if you notice that your frontal hairline has signs of scarring.

The diagnosis of Frontal Fibrosing Alopecia is established through a skin biopsy which analyses whether Lichen Planopilaris is present. Areas with remaining hairs are studied to find evidence of scalp inflammation.

A woman having a steroid injection to treat her frontal fibrosing alopecia

How Do You Treat Frontal Fibrosing Alopecia?

Due to the lack of research about FFA, scientists haven’t discovered a cure for this type of hair loss. However, the British Association of Dermatologists have identified several treatment options, but their success is variable and sometimes no treatment is effective.

Treatments include:

  • Topical corticoteroids (steroid cream)
  • Intralesional steroids (steroid injections)
  • Immunotheraphy
  • Finasteride
  • Topical Tacrolimus
  • Antibiotics

A SDHI hair transplant is sometimes considered for treating Frontal Fibrosing Alopecia, however, it is only possible if your condition has stabilised. The cause also affects whether the hair can be restored with this surgery. Therefore you will need to consult a doctor for an assessment.


Frontal Fibrosing Alopecia is caused by Lichen Planopilaris which causes red, itchy bumps and inflammation above and below the surface of the scalp. The inflammation destroys the hair follicles along the hairline which causes permanent scarring in a band-like pattern.

Overall, the cause of the condition is unknown because it is rare, therefore treatments haven’t been widely studied. Doctors have found some effective remedies, however, the success rate varies from patient to patient.

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