Frontal fibrosing alopecia in London — the rising cause of hairline loss in women
Frontal fibrosing alopecia now accounts for more than 1 in 5 hairline-loss consultations in London women over 50. Speed of diagnosis decides speed of arrest.
Dr. Amara Okafor
Consultant Trichologist · Harley Street
In short
- Progressive band-like recession of the frontal hairline.
- Eyebrow loss in ~80% of cases — often the first sign.
- Treatment arrests but doesn't reverse.
- Sunscreens on the face have been proposed as a trigger — evidence mixed.
Frontal fibrosing alopecia (FFA) is a scarring alopecia that principally affects post-menopausal women. Prevalence has genuinely increased in the last two decades — not just detection — and it's now the fastest-growing hair-loss diagnosis in London specialist clinics.
The pattern
- Slow, symmetric band-like recession of frontal hairline
- Loss of eyebrows in ~80% (often precedes scalp loss by years)
- Perifollicular erythema at active band edge
- Loss of vellus hairs at the affected border
- Sometimes body hair loss, facial papules
Treatment options in London
Antimalarials (hydroxychloroquine) are first line. 5-alpha reductase inhibitors (finasteride, dutasteride) — surprisingly — have shown benefit in FFA and are widely prescribed. Topical clobetasol, intralesional triamcinolone for active edge. Newer: JAK inhibitors under trial.
The trigger question
Facial sunscreens (particularly those with certain UV filters) have been epidemiologically linked to FFA in multiple studies. Evidence is not conclusive but many London specialists advise mineral-only sunscreens for affected patients. Environmental endocrine disruptors are the leading hypothesis.
FFA is the disease that made trichology hurry up.
Frequently asked
Common questions
Will my hairline come back?+
Scarred areas don't regrow. Treatment holds the line where it is.
Can I still have highlights?+
Yes — bleach and colour are safe for the follicles that remain. Avoid tension styles.
Is a transplant possible?+
Only if disease is quiet for 2+ years. Results variable. Discuss carefully.
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