Hair loss types: Frontal fibrosing alopecia signs and symptoms

Where does frontal fibrosing alopecia develop on the body?

This type of hair loss develops on the scalp, usually beginning as a receding hairline. The receding hairline tends to appear in the front or along the temples.

Along with losing hair on their scalp, some people see less hair on another area of their body. Frontal fibrosing alopecia (FFA) can cause noticeable hair loss anywhere hair grows.

After the scalp, the most common areas for hair loss are:

• Face (eyebrows and beard area most common)

• Arms

• Legs

• Pubic area

What are the signs and symptoms of frontal fibrosing alopecia?

Before you see noticeable hair loss, you may develop symptoms. The following explains what symptoms people may develop and shows what FFA can look like.

Itchy or painful scalp

Before seeing noticeable hair loss, many people who develop FFA remember feeling some discomfort on their scalp. Common early symptoms are itch or pain.

Rash along hairline, face, or scalp

Some people develop a rash before they see noticeable hair loss. This rash of small bumps may be red, skin-colored, or yellow. The bumps often feel scaly.

Loss of eyebrows

Many people who have FFA see noticeable eyebrow loss. You may notice thinner eyebrows or hair loss along the outer edges before you notice a receding hairline. As hair loss on the scalp progresses, some people see complete loss of their eyebrows.

Receding hairline (early)

This 30-year-old woman has noticeable hair loss, which looks like a band of lighter skin, on her forehead and temples. This is a common sign of FFA.

Hair loss spreads

With time, the hair loss grows more noticeable. Most people see the hair loss spread backward, as shown here. FFA can also cause hair loss that appears in a zigzag pattern or as balding patches.

Advanced hair loss

Without treatment, hair loss tends to spread. As FFA advances, the hairline usually moves back on the scalp as shown here.

Small, raised bumps on the face

Along with a receding hairline, some people develop small, raised bumps on their face. The pimple-like spots on this man’s face are due to FFA.

Loss of hair in beard area

While most people who develop this type of hair loss are women, men can develop FFA. In men, signs of FFA include a receding hairline, loss of eyebrows, and the patchy beard growth shown here.

Hair loss on arms, legs, or elsewhere

Aside from causing a receding hairline that tends to spread slowly, FFA can cause permanent hair loss anywhere on the body. This man developed a patch of complete hair loss on his lower arm.

A few white hairs change color

While this is rare, a few patients who have snow-white hair have noticed that some of their former natural hair color returns. This typically only happens to a few hairs, but the effect can be noticeable.

As researchers learn more about FFA, they are discovering that some people have a higher risk of developing this type of hair loss. Find out if you do, by going to: Frontal fibrosing alopecia: Causes.

Images
Images 1, 10: Getty Images

Images 2-9: Journal of the American Academy of Dermatology:

• Image 2: J Am Acad Dermatol 2017;77:683-90.

• Image 3: J Am Acad Dermatol 2005;52:55-60.

• Images 4,5: J Am Acad Dermatol 2014;70:670-8.

• Image 6: J Am Acad Dermatol 2016;75:1081-99.

• Images 7-9: J Am Acad Dermatol 2014;70:670-8.

References
Bernárdez C, Saceda-Corralo D, et al. “Beard loss in men with frontal fibrosing alopecia.” J Am Acad Dermatol. 2021;20:S0190-9622(21)00179-1. [Online ahead of print].

Brandi N, Starace M, et al. “The doll hairline: A clue for the diagnosis of frontal fibrosing alopecia.” J Am Acad Dermatol. 2017;77(5):e127-8.

Gamret AC, Potluri VS, et al. “Frontal fibrosing alopecia: Efficacy of treatment modalities.” Int J Womens Health. 2019 Apr 29;11:273-85.

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.

Tosti A, Piraccini BM, et al. “Frontal fibrosing alopecia in postmenopausal women.” J Am Acad Dermatol. 2005;52(1):55-60.

Vano-Galvan S, Molina-Riuz AM, et al. “Frontal fibrosing alopecia: A multicenter review of 355 patients.” J Am Acad Dermatol. 2014;70:670–8.

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