Frontal fibrosing alopecia, or frontotemporal hairline recession, is a clinical condition experienced most commonly by post-menopausal women, but not limited to them. It causes progressive complete hair loss from the front and sides of the head in a band-like formation. Its cause is unknown and there are no known treatments, although there are some medications available which may slow or disrupt its course. The condition is commonly confused with other forms of alopecia and may be found in combination with them. Specialist advice should be sought for diagnosis.
Hair loss, or alopecia, of any kind in women can be very disturbing and requires early diagnosis and management. Many causes of female alopecia can be successfully treated. Frontal fibrosing alopecia may be especially debilitating as it causes complete loss of hair in the area, not just thinning, and the exposed skin may look pale or scarred. It usually affects the front of the hair line and sides of head but, in some cases, the eyebrows, eyelashes and body hair may also be lost.
While what causes frontal fibrosing alopecia is still not known, doctors suspect that it may be related in some way to the immune system, which seems to attack the hair follicles causing inflammation and then permanent damage. The scalp around the follicles may be red and inflamed during this process. Once the hair is gone, it is usually pale or scarred.
The condition may be slow or rapid and there is no treatment available to cure it. Various medications, including oral and topical steroids, topical calcineurin inhibitors such as tacrolimus and pimecrolimus, immunosuppressive drugs such as cyclosporine and mycophenolate mofetil and oral antimalarials such as hydroxychloroquine have been used to slow the progression of frontal fibrosing alopecia.
These drugs are not without possible adverse effects, especially when used long-term, which is often necessary with frontal fibrosing alopecia, so the prescribing doctor will treat carefully, on a patient-by-patient basis, according to the symptoms, severity and progression of the disease. Prescribed treatment may interact with other medications so these should be disclosed to the prescribing doctor. This includes over-the-counter, homeopathic and complementary medicines.
Destroyed hair follicles do not regenerate, so once the damage is done, regrowth will not occur. A wig or hairpiece may be recommended, or the use of hair bands and clever hairstyling. Psychological support, including support groups, is often recommended as the condition may cause body image problems.