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Health-Related Quality of Life and Frontal Fibrosing Alopecia

The experience of developing hair loss is one that many people find traumatic. However, it is often a source of comfort to know that, in many instances, there are treatment options available.

This is not the case for the relatively rare condition Frontal Fibrosing Alopecia (FFA), though, which is a form of scarring that presents as a receding hairline in women – though sometimes it can affect men too. It creates a thick, mostly even, band of smooth, bald skin, which is often pale, around the frontal hairline and is part of a group of conditions collectively known as cicatricial alopecia.

It is believed to be caused by a disturbed immune response, resulting in inflammation which then damages, often destroying, the hair follicles. It has also been linked to thyroid issues.

Hair Loss Research StudyNow, a research letter published in the JAMA Dermatology journal on 7th March 2018, has explored what living with this type of often permanent hair loss can mean in terms of real-life impact. It was authored by doctors from Ramon y Cajal University Hospital, and  the Department of Medicina and Medical Specialties at the University of Alcalá, Alcalá de Henares, both in Madrid, Spain.

Health-related quality of life assessed

The Spanish researchers explain the reasoning behind their work as follows: ‘Alopecia has a negative association with health-related quality of life (HRQOL). To our knowledge, there are no large studies focusing on HRQOL in patients with frontal fibrosing alopecia (FFA), The aim of our study was to describe the association between HRQOL, psychological distress, and perception of disease in a large series of patients with FFA.’

Approved questionnaires were completed by 82 female patients with varying degrees of FFA who had been diagnosed at the Ramon y Cajal University Hospital between 1st January 2016 and 28th February 2017.  These included the Dermatology Life Quality Index (DLQI), the Hospital Anxiety and Depression Scale (HADS), and the Revised Illness Perception Questionnaire (IPQ-R), from which statistical analysis was drawn.

Of these 82 participants, the mean age was 59.3 years old with a mean FFA onset age of 55.7 years old, and all completed at least one of these questionnaires.

The findings showed that most of the women believed stress (44.6 per cent) and altered immunity (44.4 per cent) to be the key factors in them developing this hair loss condition, with ageing and ‘bad luck’ also receiving high scores. Only 4.5 per cent of those surveyed believed their FFA had ‘significant consequences on their lives’.

Interestingly, whilst the mean levels of participants’ psychological distress were low, coming in at just 3.6 per cent, symptoms of anxiety and depression were certainly present, with 18.8 per cent registering as moderate, and 6.3 per cent as severe.

Treating Frontal Fibrosing Alopecia

An example of Frontal Fibrosing Alopecia (FFA)

Given FFA is a form of scarring, it causes permanent hair loss. It is sometimes known as ‘postmenopausal frontal fibrosing alopecia’ due to its links to hormonal fluctuations most commonly seen in women who have been through the menopause. Although its symptoms are highly visual, a scalp biopsy is a good method of ensuring a proper diagnosis of FFA.

In terms of managing the condition, oral steroids or anti-malarial drugs may be used but this is something a doctor would prescribe – it is not a condition that Belgravia hair loss specialists treat.

In some rare cases surgical restoration may be possible though this depends on many factors, including the extent of the recession and there being sufficient, good quality donor hair available. Whether or not a patient is suitable for a hair transplant in cases of Frontal Fibrosing Alopecia is decided very much on a case-by-case basis. That said, it is important to remember that underlying issues with inflammation may make surgery an unlikely option here.

Whilst options are currently extremely limited, there is on-going research into potential treatments, including the use of PRP for FFA. The development of hair replication techniques, where artificial skin containing working hair follicles capable of producing hair are created in vitro and transferred to the scalp, may provide a ray of hope to FFA patients. It is certainly an exciting area of research and, whilst it has been going on for some time and may still take a number of years to confirm its safety and efficacy, it does appear that scientists are closer to finding a solution to this form of hairloss than ever before.


circ - The Belgravia Centre Hair Loss Clinic - For Men and WomenThe 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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