Frontal Fibrosing Alopecia (FFA): Causes, Symptoms And Treatment
Last reviewed on 3 August 2026. We review our treatment guides every six months to keep them accurate.
What is frontal fibrosing alopecia (FFA)?
Frontal fibrosing alopecia (FFA) is a form of scarring hair loss in which the hairline at the front of the scalp slowly recedes, usually leaving a band of pale, slightly shiny skin where the hair used to be. It very commonly comes with thinning or loss of the eyebrows, and sometimes hair loss from the sides of the scalp near the ears or from other parts of the body. It affects mostly women around and after the menopause, although it can also occur in younger women and in men. It is considered a variant of a related condition called lichen planopilaris.
The single most important thing to understand about FFA is that it is a scarring, or cicatricial, alopecia. The inflammation that drives it destroys the hair follicle itself and replaces it with scar tissue, so once a hair has been lost from the affected area it will not grow back. This is what separates FFA from ordinary pattern hair loss, in which the follicle shrinks but survives and can often be coaxed back. Because of it, the aim of treatment is not to regrow what has already gone but to halt or slow the condition as early as possible, which is why an early diagnosis genuinely matters.
This guide explains what FFA is, who it affects, what it looks and feels like, what causes it, how it is treated and what the outlook is, and it gives an honest answer on whether a hair transplant is suitable. For the current UK clinical position, the British Association of Dermatologists patient leaflet on frontal fibrosing alopecia is the authoritative source and is written by dermatologists.
Who gets frontal fibrosing alopecia?
According to the British Association of Dermatologists, FFA occurs mostly in white postmenopausal women, but it can also affect premenopausal women, men and people of other ethnicities. It was first described as recently as 1994, by the dermatologist Kossard, and DermNet notes that it now appears across all ethnic groups and that women of African descent often present earlier, frequently in their early 40s before the menopause. Why it targets the front of the scalp in particular is not understood.
Symptoms and what it looks like
FFA develops slowly, and the earliest change is often the eyebrows thinning rather than anything obvious at the hairline. The main features are:
A frontal hairline that gradually recedes in a fairly even, band-like pattern, often extending to the sides of the scalp near the ears.
Thinning or complete loss of the eyebrows, which frequently comes before the scalp changes and is sometimes the first sign.
Pale, smooth, slightly shiny skin left behind where the hairline has moved back, sometimes with occasional single 'lonely' hairs standing in the bald zone.
Redness and fine scaling around individual hairs at the edge of the affected area, a sign of the underlying inflammation.
Sometimes no symptoms at all, or an itchy, painful or burning feeling in a band across the frontal hairline; small facial bumps and loss of body hair can also occur.
Because the change is gradual, FFA is easily mistaken for a naturally maturing hairline. The two are different, and telling them apart is a job for a clinician: our guide on the difference between a mature and a receding hairline explains the usual, harmless kind of hairline change, but a hairline that recedes in an even band together with eyebrow loss, redness or scarring is a reason to see a doctor rather than to wait.
What causes frontal fibrosing alopecia?
The honest answer is that the cause is not known. What is understood is that immune cells called lymphocytes attack the hair follicles and cause the inflammation that scars them. The British Association of Dermatologists states that genetics, an overactivity of the body's immune system and, possibly, hormones are thought to play a role, the hormonal idea partly reflecting how commonly the condition appears around and after the menopause. Environmental triggers, including a suggested link with ingredients in some cosmetics and sunscreens, have been investigated but not proven. FFA is not an inherited condition, although it has occasionally been reported in more than one member of the same family.
Can frontal fibrosing alopecia be cured or stopped?
There is no cure for FFA, and hair already lost to scarring cannot be brought back. What treatment can do, in some people, is slow down or halt further hair loss, which is why starting early, before more follicles are scarred, is so important. The British Association of Dermatologists is clear that success is variable and that some people do not find a treatment that works for them. There is a reassuring side to the outlook, though: the condition is usually slowly progressive and often becomes inactive over time, and DermNet describes it as tending to be self-limiting after several years.
Treatment aims to calm the inflammation and hold the hairline where it is. A dermatologist may use topical corticosteroids or steroid injections into the scalp, a topical calcineurin inhibitor such as tacrolimus, anti-inflammatory antibiotics from the tetracycline family, hydroxychloroquine, or an immune-modulating tablet such as mycophenolate mofetil. Where an element of ordinary pattern hair loss is contributing as well, a 5-alpha-reductase inhibitor such as finasteride or dutasteride is sometimes added. These are prescription medicines with their own monitoring needs, and the right choice is a matter for your own dermatologist rather than something to attempt alone; this guide names the options only to explain what treatment involves.
Can you have a hair transplant for frontal fibrosing alopecia?
Generally not, and this is a point worth being straightforward about rather than encouraging. FFA is a scarring alopecia driven by an active immune process, and that same process can attack transplanted follicles just as it attacked the original ones, so a transplant into an active, inflamed hairline is likely to fail. The scarred skin is also a poor host for grafts. For these reasons a transplant is only even considered once the disease has been inactive for a long period, as DermNet notes that grafting 'may be considered once disease activity has settled', and even then the results are uncertain and it would be a private undertaking, not something offered on the NHS.
This caution comes from direct surgical experience, not theory alone. The surgeon who reviewed this page has attempted a hair transplant for frontal fibrosing alopecia in only a small number of patients, and in most the result was disappointing: of three such transplants, two failed. Their own recommendation, on that basis, is not to undergo a hair transplant for active FFA, because the same scarring process that caused the hair loss can go on to attack the transplanted hair.
The practical consequence is that for most people with FFA the priority is bringing the condition under control with a dermatologist, not surgery, and a responsible clinic will often advise against a transplant. Anyone told they can proceed while the condition is still active, or without a frank discussion of the risk that the disease attacks the grafts, is not being served well. FFA is one of several scarring conditions where this caution applies. If your diagnosis is uncertain, our guides on central centrifugal cicatricial alopecia, another scarring alopecia, and on alopecia areata, a non-scarring condition that can look similar, may also help, though only a clinician can tell these conditions apart.
Living with frontal fibrosing alopecia and where to get support
Many people find the experience of FFA distressing, particularly because it affects the visible frontal hairline and the eyebrows, and support is a legitimate part of managing it. For the eyebrows, eyebrow pencils, semi-permanent tattooing and microblading can restore their appearance. For the scalp, wigs and hairpieces can be bought privately or, in many cases, obtained through the NHS on a consultant's prescription, and some people with longer hair use extensions to camouflage the hairline, though it is worth keeping tension low so the pulling does not add a separate, preventable hair loss called traction alopecia. Protecting any exposed skin at the hairline from the sun is also sensible.
For information and peer support, Alopecia UK is a well established charity covering all forms of hair loss, and it is the support organisation the British Association of Dermatologists itself lists in its leaflet.
When should you see a doctor?
Sooner rather than later. Because the hair loss becomes permanent once the follicles scar, and because treatment works best before that happens, a frontal hairline that seems to be receding in an even band, unexplained thinning of the eyebrows, or a scalp that itches, burns or looks red along the hairline is worth having assessed. In the UK the route, as NHS advice on hair loss sets out, is usually to start with your GP, who can refer you to a dermatologist. The diagnosis is based on the appearance of the hairline, and a small scalp biopsy is sometimes taken under local anaesthetic to confirm it. This guide is general information and not a substitute for that assessment.
Frequently asked questions
Does hair grow back with frontal fibrosing alopecia?
No. FFA is a scarring alopecia, so once a hair has been lost from the affected area the follicle has been destroyed and replaced by scar tissue, and it cannot regrow there. This is why early treatment matters: it cannot recover hair that has already gone, but it can help protect the follicles that are still alive by slowing or halting the condition.
What is usually the first sign of frontal fibrosing alopecia?
Often it is the eyebrows, which frequently thin or disappear before there is any obvious change at the hairline. On the scalp, the first sign is usually a frontal hairline that recedes in an even band, sometimes with redness or fine scaling around the hairs. Because these changes are gradual, they are easy to dismiss, which is part of why the condition is often caught late.
Can frontal fibrosing alopecia be cured or stopped?
There is no cure, but in many people the condition can be slowed or halted with treatment from a dermatologist, and it often becomes inactive on its own over time. Treatment aims to calm the inflammation and preserve the remaining hair rather than to regrow what has been lost, so it works best when started early.
Can you have a hair transplant for frontal fibrosing alopecia?
Generally not. Because FFA is an active scarring condition, the same immune process can attack transplanted follicles, so a transplant into an inflamed hairline is likely to fail, and the scarred skin is a poor host for grafts. A transplant is only even considered once the disease has been inactive for a long period, the results are uncertain, and a responsible clinic will often advise against it. It is not available on the NHS.
Is frontal fibrosing alopecia hereditary?
It is not an inherited condition, although the British Association of Dermatologists notes that it has occasionally been reported in more than one member of the same family, and genetics is thought to be one of the factors involved. Having a relative with FFA does not mean you will develop it.
Does frontal fibrosing alopecia eventually stop on its own?
Often, yes. FFA is usually slowly progressive but tends to become inactive over time and is frequently self-limiting after several years, meaning the hairline settles at a new position. It is not possible to predict in advance how far it will progress before it quietens, which is why treatment to slow it and an early assessment are still worthwhile.
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