Raechele Cochran Gathers, MD Typically, thinning and bald edges are caused by traction alopecia, and things that we do to our hair. Thankfully, traction alopecia is often treatable and can be avoided. But did you know that there is another cause of bald edges? That’s right. There’s a medical condition that can cause permanent damage to your scalp and permanent loss of your edges? That condition is called frontal fibrosing alopecia.
Frontal Fibrosing Alopecia
Frontal fibrosing alopecia (FFA) is a fairly new disease. It wasn’t even first reported as a cause of balding and thinning edges until 1994! Frontal fibrosing alopecia is a subtype of an inflammatory skin disease called lichen planopilaris. Frontal fibrosing alopecia (FFA) causes balding of your edges. It can look a lot like traction alopecia, but there are some significant differences in how it looks and how traction hair loss looks.
Frontal fibrosing alopecia (FFA) is typically permanent. It’s what we call a scarring alopecia—meaning it scars down your hair follicles. CCCA, a type of hair loss that affects many black women, is also a type of permanent scarring alopecia. In FFA, the inflammation in your scalp damages your hair follicles and causes permanent balding of your edges. That’s why it’s important to diagnose and treat FFA early, before permanent damage occurs.
Miteva M et al. Br. J Derm, Jan 2012
Who Gets Frontal Fibrosing Alopecia?
The majority of FFA patients are postmenopausal women. However, around 20% of cases occur in younger women that haven’t reached menopause. Men can be affected too.
What It Looks Like
Typically, FFA causes balding at the front of your hair line and near your temples—a lot like traction alopecia. FFA can be so aggressive that your hairline can recede back several inches from where it normally is, and the exposed skin looks lighter and smoother than the skin on the rest of your forehead. FFA can also cause balding around your ears and your nape. Another interesting thing about FFA is that it is often is associated with loss and thinning of your eyebrows. Sometimes, the eyebrow hair is lost before you notice hair loss on your scalp.
Treatment
Doctors often have several different approaches for treating FFA. Commonly, tetracycline antibiotics are used to help decrease the inflammation in your scalp. Likewise, steroid injections and steroid creams are often used. Hydroxychloroquine, an antimalarial medication that is also used to treat skin lupus, is sometimes used to treat FFA. Other medications like tacrolimus, a medication that modulates the immune system, and minoxidil, an over the counter hair growth medication, are also used to help treat FFA.
What Causes FFA?
The truth is, we’re not sure what causes FFA right now. One study suggested a possible link between FFA and facial skin care products and sunscreens, and it found that twice as many women with FFA had used sunscreens as compared to women without the disease. The data is not that clear yet, and if it’s a sunscreen or other ingredient, it’s likely to be an ingredient that wasn’t developed until the 1980’s, since FFA wasn’t even a thing until the 1990’s.
Conclusion
If you’ve got thinning and balding edges, don’t assume that it’s something that you’re doing wrong. There are other serious causes of balding edges that need to be identified so that they can be treated as soon as possible.
