Frontal Fibrosing Alopecia in Men: A Review of the Literature

March 2025 in “ Journal of Clinical Medicine ”

Ana Melián-Olivera, Adrián Imbernón-Moya, María Librada Porriño‐Bustamante, Cristina Pindado‐Ortega, Daniel Fernandes Melo, David Saceda‐Corralo

frontal fibrosing alopecia autoimmune trichoscopy biopsy 5-alpha-reductase inhibitors topical corticosteroids calcineurin inhibitors FFA

Studysummary This review discusses the unique clinical features, challenges in diagnosis, and treatment protocols of frontal fibrosing alopecia in men, noting the overlap with other types of alopecia and the need for further studies. Our plain-language summary of this paper — not a Tressless recommendation.

Frontal fibrosing alopecia (FFA) in men is an under-recognized condition often misdiagnosed due to its distinct clinical features, such as early beard and sideburn alopecia, facial papules, and body hair loss. The condition is believed to have an autoimmune basis influenced by genetic, hormonal, and environmental factors, including facial product use. Diagnosis is primarily clinical, supported by trichoscopy and biopsy, with eyebrow, sideburn, and beard alopecia being key indicators. Treatment strategies for men largely mirror those for women, focusing on disease stabilization with oral 5-alpha-reductase inhibitors, topical corticosteroids, and calcineurin inhibitors. However, current diagnostic criteria do not fully capture the male presentation, necessitating further research to validate diagnostic criteria and optimize treatment protocols for this underrepresented group.

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research Low-Dose Oral Minoxidil for Frontal Fibrosing Alopecia: A 122-Patient Case Series

February 2025 in “Actas Dermo-Sifiliográficas”

This study found that oral minoxidil can improve hair and eyebrow growth and increase the density of the frontotemporal hairline in patients with FFA, though adverse effects were reported by a third of participants.

research Evaluating Anti-Inflammatory Potential of Platelet-Rich Plasma in Scarring Alopecia: A Systematic Review

November 2024 in “Journal of Drugs in Dermatology”

This review found that platelet-rich plasma may have a positive effect on scarring alopecia by slowing progression and reducing inflammation, though evidence remains limited to case reports.

research Oral Dutasteride Is a First-Line Treatment for Frontal Fibrosing Alopecia

1 citations , July 2024 in “Journal of the European Academy of Dermatology and Venereology”

This review concludes that oral dutasteride has the highest evidence level for stabilizing frontal fibrosing alopecia and should be used as a first-line treatment until more randomized controlled trials are conducted.

research Trichoscopy of Frontal Fibrosing Alopecia Affecting Black Scalp: A Literature Review

1 citations , May 2024 in “Skin Appendage Disorders”

In this study, researchers analyzed trichoscopy findings in black patients with FFA to aid in precise diagnosis and treatment, highlighting the importance of understanding disease characteristics to improve hair care in this group.

research The 'Watch Sign' – Another Observation in the Course of Male Frontal Fibrosing Alopecia

1 citations , April 2024 in “Dermatology Practical & Conceptual”

Hair loss in male frontal fibrosing alopecia may spare areas covered by a wristwatch.

research A Review of Isotretinoin in the Treatment of Frontal Fibrosing Alopecia

March 2024 in “Journal of cosmetic dermatology”

This study found that oral isotretinoin significantly reduced symptoms in nearly 90% of patients with frontal fibrosing alopecia, affecting both facial papules and hair loss.

research Is There a Rationale for the Use of Lymecycline for Frontal Fibrosing Alopecia?

January 2024 in “Dermatology practical & conceptual”

In this publication, the authors explored whether there is a scientific basis for using lymecycline to treat frontal fibrosing alopecia, but the abstract does not provide study results or conclusions on its efficacy.

research A Retrospective Study of Frontal Fibrosing Alopecia from North-East India

November 2023 in “Indian Journal of Dermatology”

This study from North-East India analyzed 21 cases of frontal fibrosing alopecia, noting a high prevalence in post-menopausal women and distinct histological features such as perifollicular lymphocytic infiltrate and hydropic degeneration.

research Frontal Fibrosing Alopecia: An Observational Single-Center Study of 306 Cases

June 2023 in “Life”

In this retrospective study, researchers at a Spanish hospital found that the severity of frontal fibrosing alopecia, primarily affecting postmenopausal women, was correlated with the duration of the disease, though inflammatory signs were not linked with its progression.

Plasma Rich in Growth Factors as an Adjuvant Treatment for the Management of Frontal Fibrosing Alopecia: A Retrospective Observational Clinical Study

research Plasma Rich in Growth Factors as an Adjuvant Treatment for the Management of Frontal Fibrosing Alopecia: A Retrospective Observational Clinical Study

11 citations , May 2023 in “Journal of Cutaneous Medicine and Surgery”

This study found that combining plasma rich in growth factors with conventional treatment significantly improved hair regrowth and reduced symptoms in patients with frontal fibrosing alopecia compared to conventional treatment alone.

research Clinical Features and Treatment Outcomes of Frontal Fibrosing Alopecia in Men

1 citations , June 2022 in “International Journal of Dermatology”

FFA in men shows unique features and treatment results vary widely.

research Frontal Fibrosing Alopecia in Men: A Multicenter Study of 39 Patients

5 citations , September 2021 in “Journal of The American Academy of Dermatology”

This study found a high prevalence of beard and eyebrow alopecia in male patients with frontal fibrosing alopecia, and suggests a potential link between hormonal imbalances and the condition.

research Trichoscopy of the Beard: Aid Tool for Diagnosis of Frontal Fibrosing Alopecia in Men

2 citations , July 2021 in “JAAD Case Reports”

This case study suggests that trichoscopic examination of the beard can aid in diagnosing frontal fibrosing alopecia in men, especially when challenging to differentiate from androgenetic alopecia.

Guidelines for Clinical Trials of Frontal Fibrosing Alopecia: Consensus Recommendations from the International FFA Cooperative Group

research Guidelines for Clinical Trials of Frontal Fibrosing Alopecia: Consensus Recommendations from the International FFA Cooperative Group

14 citations , June 2021 in “British journal of dermatology/British journal of dermatology, Supplement”

This paper presents consensus guidelines for standardized diagnostic criteria and assessment methods for frontal fibrosing alopecia to improve clinical research and data collection globally.

research Clinical Features and Sex Hormone Profile in Male Patients with Frontal Fibrosing Alopecia: A Multicenter Retrospective Study with 33 Patients

1 citations , April 2021 in “Journal of The American Academy of Dermatology”

Some overweight or obese men with long-term frontal fibrosing alopecia may have abnormal sex hormone levels.

research Frontal Fibrosing Alopecia: A Review

23 citations , April 2021 in “Journal of Clinical Medicine”

This review compiles existing data on frontal fibrosing alopecia and highlights the promise of 5-alpha reductase inhibitors as a treatment option, while noting the need for clarity on its cause and progression.

research Eyebrow Regrowth in Patients with Frontal Fibrosing Alopecia Treated with Low-Dose Oral Minoxidil

8 citations , December 2020 in “Skin appendage disorders”

This study observed eyebrow regrowth in 7 patients with frontal fibrosing alopecia treated with low-dose oral minoxidil, suggesting it may be a promising treatment option, especially in early disease stages.

research Medical Comorbidities and Sex Distribution Among Patients With Lichen Planopilaris and Frontal Fibrosing Alopecia: A Retrospective Cohort Study

22 citations , August 2020 in “Journal of the American Academy of Dermatology”

Women with lichen planopilaris and frontal fibrosing alopecia often have other health issues like hypothyroidism and lupus.

research Therapeutic Response of Facial Papules and Inflammation in Frontal Fibrosing Alopecia to Low-Dose Oral Isotretinoin

7 citations , April 2020

This article discusses the features and increasing prevalence of frontal fibrosing alopecia, a type of scarring hair loss, and reports no new clinical results.

Oral Isotretinoin Combined with Topical Clobetasol 0.05% and Tacrolimus 0.1% for the Treatment of Frontal Fibrosing Alopecia: A Randomized Controlled Trial

research Oral Isotretinoin Combined with Topical Clobetasol 0.05% and Tacrolimus 0.1% for the Treatment of Frontal Fibrosing Alopecia: A Randomized Controlled Trial

11 citations , April 2020 in “Journal of Dermatological Treatment”

This study found that combining oral isotretinoin with topical treatments was more effective than topical treatments alone for improving frontal fibrosing alopecia symptoms, despite some side effects.

research Frontal Fibrosing Alopecia: Demographic and Clinical Characteristics of 490 Cases

53 citations , June 2019 in “JEADV. Journal of the European Academy of Dermatology and Venereology/Journal of the European Academy of Dermatology and Venereology”

This study observed that abnormal hormone levels were associated with lower disease activity in frontal fibrosing alopecia, while thyroid disorders were a common comorbidity among the affected population.

research Genome-Wide Association Study in Frontal Fibrosing Alopecia Identifies Four Susceptibility Loci Including HLA-B*07:02

115 citations , March 2019 in “Nature Communications”

This study identified significant genetic associations with frontal fibrosing alopecia at four genomic loci, suggesting it is a genetically predisposed immuno-inflammatory disorder influenced by the HLA-B*07: 02 allele.

research Photopatch And Patch Testing In 63 Patients With Frontal Fibrosing Alopecia: A Case Series

24 citations , July 2018 in “British Journal of Dermatology”

Contact allergies might contribute to frontal fibrosing alopecia.

research Frontal Fibrosing Alopecia and Cutaneous Comorbidities: A Potential Relationship with Rosacea

18 citations , February 2018 in “Journal of the American Academy of Dermatology”

This study reports no new clinical results but suggests a potential relationship between frontal fibrosing alopecia and cutaneous conditions such as rosacea, indicating a need for further research.

research Frontal Fibrosing Alopecia After Antiandrogen Hormonal Therapy in a Male Patient

9 citations , January 2018 in “Journal of the European Academy of Dermatology and Venereology”

A male patient developed frontal fibrosing alopecia after antiandrogen therapy for prostate cancer.

research Case Report of Connubial Frontal Fibrosing Alopecia

6 citations , January 2018 in “International Journal of Trichology”

This report describes the first known case of frontal fibrosing alopecia in a genetically unrelated couple, suggesting the potential role of environmental factors in its development.

research Frontal Fibrosing Alopecia: A Retrospective Analysis of 72 Patients from a German Academic Center

25 citations , December 2017 in “Facial Plastic Surgery”

This study observed that combining high-potency steroids with pimecrolimus might effectively stabilize hairline recession in frontal fibrosing alopecia patients.

research Frontal Fibrosing Alopecia Among Men: A Clinicopathologic Study of 7 Cases

41 citations , July 2017 in “Journal of The American Academy of Dermatology”

This study observed that frontal fibrosing alopecia also occurs in men, with clinical features and areas of involvement similar to those seen in women, but often affecting sideburns and facial hair.

research Frontal Fibrosing Alopecia in a 46-Year-Old Man

2 citations , January 2016 in “Dermatology online journal”

This case report describes a 46-year-old man diagnosed with frontal fibrosing alopecia, a condition primarily affecting postmenopausal women, highlighting its rare occurrence in men.

research Case Series of Familial Frontal Fibrosing Alopecia and a Review of the Literature

33 citations , January 2015 in “Journal of Cosmetic Dermatology”

This study reports that familial frontal fibrosing alopecia was diagnosed earlier in premenopausal women compared to postmenopausal women, though long-term outcomes remain uncertain without a definitive treatment.

research Frontal Fibrosing Alopecia: A Retrospective Clinical Review of 62 Patients with Treatment Outcome and Long-Term Follow-Up

102 citations , April 2014 in “International Journal of Dermatology”

This study found that early intervention and treatment with intralesional triamcinolone acetonide may stabilize hairline recession in patients with frontal fibrosing alopecia, although further research is needed for definitive treatment guidelines.

research Frontal Fibrosing Alopecia: A Multicenter Review of 355 Patients

339 citations , February 2014 in “Journal of The American Academy of Dermatology”

This study found that eyelash loss, facial papules, and body hair involvement were linked to severe frontal fibrosing alopecia, and antiandrogens were the most effective treatment.

research Beard Involvement in a Man with Frontal Fibrosing Alopecia

14 citations , January 2014 in “Indian Journal of Dermatology Venereology and Leprology”

Frontal fibrosing alopecia can affect men's beards and leads to permanent hair loss.

research Frontal Fibrosing Alopecia in an African Man

13 citations , August 2013 in “International Journal of Dermatology”

Frontal fibrosing alopecia can affect African men and may be underdiagnosed.

Male Frontal Fibrosing Alopecia with Generalized Hair Loss

research Postmenopausal Frontal Fibrosing Alopecia

325 citations , June 1994 in “Archives of Dermatology”

This study observed that progressive frontal recession in postmenopausal women may exhibit features of fibrosing alopecia, suggesting a distinct reaction pattern from typical lichen planopilaris.