Frontal fibrosing alopecia

Most women who have hair loss notice thinning hair on the top of their heads. This is called female-pattern hair loss. Another type of hair loss that is becoming more common in older women is a receding hairline. This condition is called frontal fibrosing alopecia (FFA). It is a form of lichen planopilaris, a condition that causes permanent hair loss on the scalp.

FFA causes swelling and irritation on the scalp around the tiny openings where hair grows, called hair follicles. The skin in these areas may look red, purple or brown, depending on your skin color. Over time, the swelling damages the hair follicles, causing the hair to fall out. As the skin heals, scar tissue forms where the hair follicles used to be. This stops new hair from growing. You can’t see the scar tissue itself, but the skin where hair is missing may look smooth and shiny.

One of the first signs of FFA may be losing hair from your eyebrows. You might notice this before your hairline starts to change. Men also can have FFA, which may cause hair loss on the face, such as the beard or sideburn areas. FFA can cause itching, burning or pain in the places where hair has fallen out or new swelling and irritation occurs.

Experts don't know exactly what causes frontal fibrosing alopecia. It may be caused by genes, hormone changes, something in the environment or an immune system condition.

While lost hair may not grow back, finding and treating FFA early may help slow or stop more hair loss. To diagnose FFA, your healthcare professional looks closely at your scalp and eyebrows and asks about your symptoms and health history. Your healthcare professional may take a small piece of skin from your scalp to check under a microscope.

If you're diagnosed with FFA, your healthcare professional may recommend one or more of these treatments:

• Steroid creams or shots. These medicines help reduce swelling and may stop the immune system from attacking the hair follicles.
• Minoxidil (Rogaine). This medicine can help slow hair loss. You can buy it without a prescription as a foam or liquid. A stronger pill form is available by prescription from your healthcare professional.
• Finasteride (Propecia) and dutasteride (Avodart). These prescription medicines can help slow hair loss. They are not safe for women who are pregnant or might become pregnant.
• Medicines that calm the immune system, such as hydroxychloroquine (Plaquenil), tacrolimus (Astagraf XL, Prograf, others) or pimecrolimus (Elidel). These help reduce swelling and may protect hair follicles from further damage.
• Antibiotics. Antibiotic medicines can reduce swelling around the hair follicles, which might help prevent further damage.

If you notice a receding hairline or thinning eyebrows, talk with your healthcare professional. Starting treatment early may help stop further hair loss.