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Study Finds Frontal Fibrosing Alopecia Hair Loss Also Occurs in Men

Women tend to be at risk of developing a wider range of hair loss issues due to hormonal fluctuations, such as those that occur during pregnancy or the menopause, which can trigger unusual shedding.

One of the hair loss conditions that has, until now, been almost exclusively associated with women is a form of scarring hair loss known as Frontal Fibrosing Alopecia (FFA).

However, a small retrospective review has discovered that seven men treated in Rochester, Minnesota, USA, were diagnosed with this rare issue between 1992 and 2016. This has led to the advice that the “distribution of hair loss and associated hormonal abnormalities” are issues to take into account when diagnosing FFA in men.

Receding hairline from lichen planopilaris

Example of Frontal Fibrosing Alopecia

An Example of Frontal Fibrosing Alopecia

Researchers have published the results of their study, conducted using the research database from the Mayo Medical Centre Minnesota, in the Journal of the American Academy of Dermatology.

Of the 182 men studied, 7 men, with a median age of 53 when they were diagnosed, were diagnosed with FFA. Following biopsies, they were all also found to have lichen planopilaris.

FFA causes a different type of receding hairline to that commonly seen in patients with Male Pattern Hair Loss. Instead of gradually thinning or causing a widow’s peak, FFA leads to a wide band of smooth bald skin around the entire frontal hairline.

It is one of a group of forms of scarring hair loss known collectively as cicatricial alopecia. These are rare hair loss conditions that are caused by inflammation, many of which are permanent and cannot be treated. Cicatricial alopecia is made up of two distinct groups: primary and secondary. Both Frontal Fibrosing Alopecia and Lichen Planopilaris are considered primary cicatricial alopecias. This means they can come on gradually and may go unnoticed for a period of time, but always attack the hair follicle directly. Secondary cicatricial alopecias occur when the follicle is damaged unintentionally, for instance as a result of fire or radiation therapy.

Hair loss from sideburns

Interestingly, whilst six of the seven men displayed the classic frontal hair loss associated with FFA, four patients also had their sideburns affected and four had hair loss in the temporal scalp region. Furthermore, four of these men had facial hair loss – three whose eyebrows were affected and one with hair loss on the upper lip.

Lichen Planopilaris

An example of Lichen Planopilaris

Whilst one of the men diagnosed with FFA was also diagnosed with male pattern baldness, none of the patients had autoimmune or thyroid issues, both of which can lead to hair loss in some instances. What was discovered, however, was that six of the seven men also had erythema, four had scalp hyperkeratosis and one presented with discoloured scalp macules.

The research paper advises that FFA is “thought to be a variant of [lichen planopilaris] based on the similarity of histopathologic findings.”

“Although [frontal fibrosing alopecia] in men is rare, it does occur and presents with clinical and histopathologic features similar to those in women with [frontal fibrosing alopecia],” it states.

“In men, however, involvement of the sideburns and facial hair is a notable finding, and eyebrow and sideburn alopecia can help distinguish [frontal fibrosing alopecia] from [androgenetic alopecia]. We hope that additional larger studies will more fully elucidate the clinical features and etiology of [frontal fibrosing alopecia] in men.”

Due to the damage generally inflicted on the follicles, the majority of cicatricial alopecias cannot be treated except, in some cases, via surgery. At Belgravia, however, hair loss treatment for Frontal Fibrosing Alopecia is often possible. Firstly, a professional diagnosis of the condition and the extent of the shedding being experienced, as well as whether there is more than one hair loss condition present simultaneously, is needed. This will allow for an accurate prognosis to be given and, where appropriate, a bespoke treatment course to be tailored.


The Belgravia CentreThe Belgravia Centre

The Belgravia Centre is the leader in hair loss treatment in the UK, with two clinics based in Central London. If you are worried about hair loss you can arrange a free consultation with a hair loss expert or complete our Online Consultation Form from anywhere in the UK or the rest of the world. View our Hair Loss Success Stories, which are the largest collection of such success stories in the world and demonstrate the levels of success that so many of Belgravia’s patients achieve. You can also phone 020 7730 6666 any time for our hair loss helpline or to arrange a free consultation.


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