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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 women of African descent 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.

While researchers continue to look for what causes frontal fibrosing alopecia (FFA), it’s believed that this may be an autoimmune disease. An autoimmune disease develops when the body attacks itself. 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 out of which hair grows). As the hair follicles heal, they scar. Once a hair follicle scars, it can no longer grow hair.

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

To better understand FFA, dermatologists continue to study this disease. It appears that the scarring 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

Heymann WR, “Frontal fibrosing alopecia: Bewitched, bothered, and bewildered.” Dermatol World Insights & Inquires. Published 2/13/2017. Last accessed 4/30/2021.

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

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
Elena B. Hawryluk, MD, PhD, FAAD
Carrie L. Kovarik, MD, FAAD
William W. Kwan, MD, FAAD
Shari Lipner, MD, PhD, FAAD

Last updated: 8/18/21