Go to AAD Home
Donate For AAD Members Search

Go to AAD Home

Hair loss types: Frontal fibrosing alopecia causes

When it begins, frontal fibrosing alopecia often looks like a receding hairline

This type of hair loss may begin at an earlier age in Black women than in white women.

Three women with early signs of hair loss running outdoors

What causes frontal fibrosing alopecia?

Much about this type of hair loss is still a mystery, including what causes it. Dermatologists continue to study frontal fibrosing alopecia (FFA) so that they can one day answer this question. Here’s what they’ve learned so far.

It’s possible that FFA is an autoimmune disease. People develop an autoimmune disease when their immune system attacks part of their own body. For example, when the body attacks its own joints, a person develops rheumatoid arthritis.

It may be that FFA develops when the body attacks its own hair follicles (openings from which hair grows).

Dermatologists have learned that when FFA develops the hair follicles can scar over. Once a hair follicle scars, it can no longer grow hair.

Where hair once grew, you’ll notice smooth, hairless skin.

Is frontal fibrosing alopecia caused by another autoimmune disease?

Researchers are trying to answer this question. In one small study of 29 patients with FFA, researchers discovered that more than half had an autoimmune disease. The autoimmune diseases that these patients had included hypothyroidism, vitiligo, and lupus.

More research is needed to determine if there is a connection between FFA and having an autoimmune disease.

Can stress cause frontal fibrosing alopecia?

Stress may trigger FFA in people who already have a risk of developing it. In a study that enrolled 29 patients with FFA (28 women and 1 man), 15 patients said they had experienced a stressful event right before developing hair loss. These stressful events included having hip-replacement surgery, starting a new medication, and being diagnosed with a disease.

Because this is one small study, more research is needed to know whether stress can trigger FFA.

Is frontal fibrosing alopecia genetic?

Researchers continue to find instances in which FFA runs in a family. As such, it’s likely that genes play a role in causing FFA.

Findings from research studies also suggests that FFA develops when someone has the right mix of:

  • Genes

  • Hormones

  • Inflammation inside the body

What increases the risk of developing FFA?

Research shows that you have an increased risk of developing FFA if you:

  • Are in menopause (have stopped having periods for one year or longer)

  • Have a close blood relative who has FFA

  • Live with one of these diseases: Rosacea, thyroid disease, or type 2 diabetes

While the above can increase your risk of developing FFA, people without the above risk factors can develop this type of hair loss. Equally important, some people with these risk factors never develop FFA.

If you notice hair loss, make an appointment to see a board-certified dermatologist. The sooner you get diagnosed and start treating FFA, the more effective treatment tends to be.

To find out what’s involved in getting diagnosed and treated, go to: Frontal fibrosing alopecia: Diagnosis and treatment.

Getty Images

Callender VD, Reid SD, et al. “Diagnostic clues to frontal fibrosing alopecia in patients of African descent.” J Clin Aesthet Dermatol. 2016;9(4):45-51

Lis-Święty A, Brzezińska-Wcisło L. “Frontal fibrosing alopecia: a disease that remains enigmatic.” Postepy Dermatol Alergol. 2020;37(4):482-9.

Litaiem N, Idoudi S. “Frontal fibrosing alopecia.” [Updated 2021 Aug 11]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan.

Ramos PM, Anzai A, et al. “Risk factors for frontal fibrosing alopecia: A case-control study in a multiracial population.” J Am Acad Dermatol. 2021;84(3):712-8.

Strazzulla LC, Avila L, et al. “Prognosis, treatment, and disease outcomes in frontal fibrosing alopecia: A retrospective review of 92 cases.” J Am Acad Dermatol. 2018;78(1):203-5.

Vañó-Galván S, Molina-Ruiz AM, et al. “Frontal fibrosing alopecia: A multicenter review of 355 patients.” J Am Acad Dermatol. 2014;70(4):670-8.

Written by:
Paula Ludmann, MS

Reviewed by:
Shani Francis, MD, MBA, FAAD
William W. Kwan, MD, FAAD

Last updated: 8/3/22

All content solely developed by the American Academy of Dermatology

The American Academy of Dermatology gratefully acknowledges support from the following companies:

Abbvie logo
Amgen logo
Bristol Myers Squibb logo
ortho dermatologics logo
Pfizer logo
Sanofi Regeneron logo