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Dr. Chrysoula I. Liakou MD, PhD
- Treated online: Assessment online. A doctor can recognise the signs on photos and arrange a dermatologist; the diagnosis and treatment are given in person.
- What it is: a scarring hair loss in which inflammation destroys the follicles along the front and sides of the hairline. Hair lost to scarring does not grow back.
- Who gets it: mostly women after the menopause, usually over 50. Younger women and men can get it too, and it is becoming more common.
- Signs: a band of pale, shiny skin where the hairline has moved back, and thinning eyebrows in 80 to 90 in 100 women with it.
- Emergency: frontal fibrosing alopecia is not an emergency. Call 112 for swelling of the face, lips or throat, or difficulty breathing, after a new medicine.
A receding hairline is not an emergency. Do not book a video appointment if you have swelling of the face, lips, tongue or throat or difficulty breathing after a new medicine, or a hot, swollen, very painful scalp with a high temperature and feel very unwell. Call 112 or go to an emergency department.
Can an online doctor treat frontal fibrosing alopecia?
Assessment online, treatment in person. Frontal fibrosing alopecia (FFA) is a scarring hair loss, and confirming it needs a dermatologist, who looks at the scalp with a magnifier and often takes a small biopsy. The treatments that slow it, such as steroid injections into the scalp and tablets, are started and monitored by a dermatologist. What a doctor by video can do is recognise the signs on clear photos and on camera, check for the conditions that look similar, arrange a dermatologist without delay, and help with camouflage, sun protection and how you feel in the meantime.
How an online consultation helps with frontal fibrosing alopecia
- The signs recognised early: Hair lost to scarring does not come back, so recognising FFA early keeps more hair.
- A dermatologist arranged: With your photos and history, so the specialist appointment starts from a clear picture.
- Look-alikes considered: Tight hairstyles, female pattern hair loss and alopecia areata can also change the hairline.
- Help in the meantime: Camouflage for the hairline and eyebrows, sun protection, and support if it is getting you down.
What the doctor checks in an online consultation for a receding hairline
The doctor asks about how the hair loss started and the other signs that come with FFA. The doctor asks about:
- Your hairline: when it started to move back, how fast, and whether the sides above and behind your ears are affected.
- Eyebrows, eyelashes and body hair: thinning or loss, which often comes before the scalp changes.
- Symptoms: itching, burning, tenderness or pain along the hairline.
- Your face: small skin-coloured or yellowish bumps on the forehead and temples, and brown or grey patches on the face or neck.
- Lichen planus: itchy purple bumps on the skin, white patches in the mouth, or nail changes.
- Hormones: the menopause, hormone treatment and the contraceptive pill.
- Products: sunscreens, moisturisers and hair dye used on the face and hairline.
- Hairstyles: tight ponytails, braids or extensions, which cause a different type of hairline loss.
- Your family: hairline loss in relatives.
Before the call, take photos in bright daylight of your hairline with your hair pulled back, the sides of your head above your ears, your eyebrows, and close-ups of the hairline edge. Older photos help show how far the hairline has moved.
What is frontal fibrosing alopecia?
Frontal fibrosing alopecia is a scarring hair loss that affects the hairline at the front and sides of the scalp, and often the eyebrows. Inflammation around the top of the hair follicles, where their stem cells sit, destroys them and replaces them with scar tissue, so the hairline slowly moves back, leaving a band of pale, smooth skin. Lost hair does not grow back.
It was first described in Australia in 1994 and is becoming more common around the world. Most people with it are women after the menopause, usually over 50. Younger women, men and people of all ethnic groups can get it; women of African descent often notice it earlier, in their early 40s. In men, it can thin the beard and sideburns.
Is frontal fibrosing alopecia an autoimmune disease?
It is thought to be an immune-driven, inflammatory condition, and it is considered a form of lichen planopilaris, the hair-follicle form of lichen planus. Gene studies have linked it with other immune conditions, but its exact cause is not known.
What are the first signs of frontal fibrosing alopecia?
Thinning eyebrows and a hairline that slowly moves back, leaving a band of pale, shiny skin. Some people notice itching or redness along the hairline, or small bumps on the forehead.
- A band of hair loss along the front and sides of the scalp, sometimes behind the ears; on average the hairline moves back by about 1.8 to 2.6 cm.
- Pale, smooth or shiny skin where the hair has gone, without the usual hair openings.
- Single hairs left behind in the bare band, called lonely hairs.
- Redness and fine scale around the hairs at the edge of the hairline.
- Thinning or loss of the eyebrows, in 80 to 90 in 100 women with FFA, often before the scalp changes.
- Small skin-coloured or yellowish bumps on the forehead and temples, more common in men.
- Brown or grey patches on the face, called lichen planus pigmentosus, more often in people with darker skin.
- Itching, burning or tenderness along the hairline, though many people have no symptoms.
- Loss of hair from the eyelashes, arms, legs or elsewhere on the body.
What does scarring alopecia look like?
Smooth, shiny skin where hair used to grow, without the tiny openings of hair follicles, often with redness and scaling around the hairs at the edge. Hair loss that does not scar, such as alopecia areata, leaves normal skin with follicle openings.
What causes frontal fibrosing alopecia?
The cause is not known. The suspected factors are:
- The immune system: immune cells gather around the stem cell area of the follicles.
- Genes: it sometimes affects more than one person in a family, including twins.
- Hormones: most people with it are women after the menopause. In people with a particular gene variant, the contraceptive pill may raise the risk.
- The environment: because it has become more common since it was first described, products applied to the face, such as sunscreens, moisturisers and cosmetics, have been suspected, but no link has been proven.
Is frontal fibrosing alopecia caused by stress?
Stress has not been shown to cause it. The suspected causes are the immune system, genes, hormones and possibly products applied to the skin. Living with hair loss is stressful, though, and support matters.
Does sunscreen cause frontal fibrosing alopecia?
This has been suggested, because FFA has become more common as facial sunscreens and moisturisers have, but it has not been proven. Sun protection remains important for your skin, and a dermatologist can advise whether to change products or arrange patch testing.
Is it frontal fibrosing alopecia or something else?
Several conditions can change the hairline. The doctor looks for these differences:
Swipe sideways to compare →
| Condition | Clues | Where to read more |
|---|---|---|
| Frontal fibrosing alopecia | A band of pale, shiny skin, lonely hairs, thinning eyebrows, often after the menopause | This page |
| Traction alopecia | Tight hairstyles; thinning where hair is pulled, with a rim of short hairs at the edge | Traction alopecia |
| Female pattern hair loss | Thinning on top and a wider parting, with the hairline usually kept | Female pattern hair loss |
| Male pattern hair loss | Recession deepest at the temples, often with a thinning crown, without scarring | Receding hairline |
| Alopecia areata | Smooth patches or a band of loss with normal skin and follicle openings | Alopecia areata |
How is frontal fibrosing alopecia diagnosed?
A dermatologist can often recognise FFA from its typical appearance, using a hand-held magnifier (trichoscopy) to look for missing follicle openings, white dots, scale and redness around the hairs. A small skin sample (biopsy) is taken when the diagnosis is uncertain; under the microscope, FFA looks the same as lichen planopilaris. Blood tests, such as thyroid function, and sometimes patch testing for allergies to products are also arranged.
How is frontal fibrosing alopecia treated?
There is no cure, and lost hair does not grow back, so treatment aims to stop the hairline moving further, as early as possible. A dermatologist chooses from injections, creams and tablets, often combined, and it usually takes 6 to 18 months to see whether the hair loss has slowed.
Swipe sideways to compare →
| Treatment | What it does | What studies show |
|---|---|---|
| Steroid injections into the hairline | Calm the inflammation at the edge | A good response in up to 84 in 100 people, used with other treatments |
| Finasteride or dutasteride tablets | Block the effect of male hormones on the follicles | A good response in about 69 in 100 |
| Hydroxychloroquine tablets | Calm the immune reaction; can ease itching and pain | A good response in about 63 in 100, usually after 6 to 12 months |
| Doxycycline tablets | An antibiotic that reduces inflammation | A good response in about 60 in 100 |
| Steroid or calcineurin inhibitor creams | Calm inflammation in the skin | Rarely enough on their own; used with other treatments |
| Minoxidil | Helps hair grow in the follicles that are left | Used alongside other treatments |
These figures come from a 2024 review of mostly small, retrospective studies, so the evidence is weak, and the condition sometimes settles on its own. Other medicines, such as immunosuppressants and JAK inhibitors, are being studied. Finasteride and dutasteride are not taken by women who could become pregnant.
Does frontal fibrosing alopecia ever go away?
It usually progresses slowly for some years and then stops on its own in most people, but the hair already lost does not grow back. Treatment aims to make it stop sooner, with more hair left.
Can hair grow back after frontal fibrosing alopecia?
Not where scarring has replaced the follicles. Hair that is thinning but still growing can sometimes be kept or partly recovered when treatment starts early, which is why a dermatologist should see you soon.
Hair transplant
A hair transplant may be considered once the condition has been settled for some time, after discussion with a dermatologist. Surgery on the hairline, including transplants, has been suggested as a possible trigger, so timing matters.
What the doctor might recommend
The next step depends on how sure the signs are and how fast the hairline is moving. This is the framework the doctors use:
Swipe sideways to compare →
| What you have | Likely next step | Suitable for online care? | When in-person care is needed |
|---|---|---|---|
| A receding hairline with thinning eyebrows after the menopause | A dermatologist, soon | Partly | For the diagnosis, a biopsy if needed, and treatment |
| Itching, burning or redness along the hairline | A dermatologist, soon, and relief for the symptoms | Partly | For treatment of the inflammation |
| Hairline loss with tight hairstyles | Looser styles, and a check for scarring | Yes | If the skin is shiny or scarred |
| Diagnosed FFA, with questions about camouflage or mood | Advice and support | Yes | Not usually needed |
| Patches of scarring elsewhere on the scalp, with pustules or crusts | A dermatologist, for scarring hair loss | Partly | For samples, a biopsy and treatment |
Hairline moving back or eyebrows thinning? A doctor can check the signs and arrange the next step in one consultation.
See available times →Living with frontal fibrosing alopecia
Many people use hairstyles, wigs or hairpieces, and eyebrow make-up or tattooing, to make the changes less noticeable. Protect the bare skin of the hairline from the sun with a hat or sunscreen.
Losing your hairline and eyebrows can affect how you feel about yourself. Peer support groups and charities for people with alopecia and scarring alopecia can help, and the doctor can help with anxiety or low mood: see anxiety and depression.
Other types of scarring hair loss
Frontal fibrosing alopecia is one of several scarring alopecias, also called cicatricial alopecias. They share one rule: hair lost to scarring does not come back, so early treatment by a dermatologist matters.
Swipe sideways to compare →
| Type | Who usually gets it | What it looks like | Treatment |
|---|---|---|---|
| Lichen planopilaris | Young adult women, and sometimes men | Smooth white patches with redness and scale around the hairs at the edge; itching, burning or tenderness | Steroid creams and injections, hydroxychloroquine, doxycycline and other tablets |
| Folliculitis decalvans | Adults in their 30s and 40s, more often men | Pustules and crusts, often around the crown, with tufts of several hairs from one opening | Courses of antibiotics, and steroids; it tends to come and go for years |
| Central centrifugal cicatricial alopecia | Mostly middle-aged Black women | Hair loss starting at the crown and spreading outwards; breakage, itching or tenderness | Stopping heat, tight styles and harsh chemicals, steroid creams or injections, and doxycycline |
Each needs a dermatologist, and often a biopsy from the active edge of a patch. A painful, spreading patch with pustules can also be an infection: see scalp ringworm and folliculitis.
Special situations
Men
Men can lose hair from the beard and sideburns as well as the hairline, and small bumps on the face are more common in men. The diagnosis and treatment are the same.
Pregnancy and planning a pregnancy
Some FFA treatments, such as finasteride and dutasteride, are not used by women who could become pregnant, so tell the dermatologist about any plans for pregnancy.
Children
Mobi Doctor consultations are for adults aged 18 and over. A child who is unwell needs a paediatrician or a local doctor in person, and emergency signs in a child mean 112.
When frontal fibrosing alopecia is assessed online, and when you need in-person care
Assessed online: recognising the signs on photos and camera, telling FFA from look-alikes such as traction alopecia, arranging a dermatologist, and advice on camouflage, sun protection and mood.
In-person care: the diagnosis with trichoscopy and often a biopsy, steroid injections, tablets such as hydroxychloroquine, finasteride or doxycycline, follow-up of the hairline, and decisions about a hair transplant.
When to get in-person care
Call 112 or go to an emergency department now for:
- swelling of the face, lips, tongue or throat after a new medicine
- difficulty breathing or swallowing
- a hot, swollen, very painful scalp with a high temperature and feeling very unwell
Get medical advice the same day for:
- a painful, swollen patch on the scalp, or pustules that are spreading
- a widespread rash or blistering after starting a new tablet
How Mobi Doctor works
- Book a time that suits you: daily 7am–11pm CEST. You can see a doctor over video, usually within 15 minutes. No subscription, and the exact price is shown before you pay.
- Speak to a licensed doctor about your hairline: show your hairline with your hair pulled back, the sides of your head and your eyebrows on camera, and share older photos if you have them.
- Leave with a plan: whether the signs fit frontal fibrosing alopecia, how the dermatologist appointment is arranged, what to do in the meantime, and which signs mean you should be seen sooner.
No sign-up needed
Not sure it’s frontal fibrosing alopecia? Tick every symptom you have to see each condition page that mentions it. It finds the right page, not a diagnosis: a doctor gives you that on a video call.
Tap the body — an area or a point — to browse symptoms anywhere
Similar symptoms, different condition? Traction Alopecia can start the same way. Compare them, or look up any other symptom in the full symptom checker.
Frequently asked questions about frontal fibrosing alopecia
What is frontal fibrosing alopecia?
A scarring hair loss that slowly moves the hairline back at the front and sides, often with thinning eyebrows. It mostly affects women after the menopause, and hair lost to scarring does not grow back.
What are the first signs of frontal fibrosing alopecia?
The first signs of frontal fibrosing alopecia are thinning eyebrows and a hairline that moves back, leaving a band of pale, shiny skin, sometimes with single hairs left in it, itching, redness or small bumps on the forehead.
Does frontal fibrosing alopecia ever go away?
Frontal fibrosing alopecia usually progresses slowly for some years and then stops on its own in most people, but the hair already lost does not grow back. Treatment aims to make it stop sooner.
How do you treat frontal fibrosing alopecia?
For frontal fibrosing alopecia, a dermatologist uses steroid injections into the hairline, tablets such as finasteride, hydroxychloroquine or doxycycline, and creams, often combined. The aim is to stop the hairline moving further.
Can hair grow back after frontal fibrosing alopecia?
Not where scarring has replaced the follicles: in frontal fibrosing alopecia the hair that has gone from the pale, shiny band is permanent. Thinning hair that is still growing at the edge can sometimes be kept or partly recovered when treatment starts early, which is why a receding hairline with thinning eyebrows should be seen quickly rather than watched.
Is frontal fibrosing alopecia caused by stress?
Stress has not been shown to cause frontal fibrosing alopecia. The suspected causes are the immune system attacking the stem cell area of the follicles, genes, since it sometimes affects more than one person in a family, hormones, because most people with it are women after the menopause, and possibly products applied to the skin. Stress can make any hair loss harder to live with, but it is not the driver here.
Is frontal fibrosing alopecia an autoimmune disease?
Frontal fibrosing alopecia is thought to be immune-driven and is considered a form of lichen planopilaris, the hair-follicle form of lichen planus. Its exact cause is not known.
Does sunscreen cause frontal fibrosing alopecia?
It has been suggested, because FFA has become more common as facial sunscreens have, but it has not been proven. A dermatologist can advise on products and patch testing.
Can frontal fibrosing alopecia be prevented?
There is no proven way to prevent frontal fibrosing alopecia, because its cause is not known, but you can limit the damage: get a receding hairline with thinning eyebrows seen early, since treatment only stops it moving further and cannot restore what is lost; avoid harsh treatments, tight styles and hairline surgery, which have been suggested as triggers; and discuss facial sunscreens and cosmetics with a dermatologist, as a link has been suggested but not proven.
What does scarring alopecia look like?
Scarring alopecia looks like smooth, shiny skin without the usual follicle openings where hair used to grow, often with redness and scale around the hairs at the edge; in frontal fibrosing alopecia this appears as a pale band along the hairline. Non-scarring hair loss, such as alopecia areata or pattern hair loss, keeps the follicle openings, which is one of the things a dermatologist checks with a magnifier.
What is lichen planopilaris?
An uncommon inflammatory condition that destroys hair follicles and causes patches of scarring hair loss, often with itching, burning or tenderness. Frontal fibrosing alopecia is a form of it.
Can a hair transplant help frontal fibrosing alopecia?
Sometimes, once the frontal fibrosing alopecia has been settled for some time, after discussion with a dermatologist. Hairline surgery has been suggested as a possible trigger, so timing matters.
Can an online doctor help with frontal fibrosing alopecia?
A doctor can recognise the signs of frontal fibrosing alopecia on photos and camera, check for the conditions that look similar, and arrange a dermatologist quickly, because early treatment keeps more hair. The diagnosis, which may need a small skin biopsy, and the treatment with injections and tablets need a dermatologist in person; between visits, a doctor by video can help with flares, side effects and questions.
- Frontal fibrosing alopecia, DermNet, New Zealand, revised 2020, updated 2024.
- Frontal fibrosing alopecia, Cleveland Clinic (US), updated 13 June 2022.
- Frontal fibrosing alopecia (FFA), Alopecia UK, updated 6 February 2026.
- The frontal fibrosing alopecia treatment dilemma, Krzesłowska WJ, Woźniacka A. Journal of Clinical Medicine, 2024.
- Frontal fibrosing alopecia, Primary Care Dermatology Society (UK), updated 22 November 2021.
- Lichen planopilaris, DermNet, New Zealand, updated 2022.
- Folliculitis decalvans, DermNet, New Zealand, updated November 2025.
- Central centrifugal cicatricial alopecia, DermNet, New Zealand, 2014, updated 2025.
- Finasteride: fertility and pregnancy, NHS, National Health Service (UK), reviewed 2 August 2023.
This page is for information only and is not a substitute for a medical consultation. Guideline links are provided for transparency; treatment decisions are made with your doctor.
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