Frontal Fibrosing Alopecia (FFA): Diagnosis & Treatment

Donovan is a Canadian dermatologist specializing in hair loss. In this 1 hour 15 minute video, Dr. Donovan discusses an approach to the diagnosis and treatment of frontal fibrosing alopecia, a type of scarring alopecia that is increasing in prevalence around the world. Dr. Donovan discusses (1) what is known about the condition, (2) how to properly diagnose it, (3) conditions are common mimickers and (4) the treatments that have the best evidence in treating it. This lecture was given as part of a hair lecture series to visiting physicians in August 2019.

[@jess-raeoliver3628]

I have been diagnosed with this condition and it has driven me into a deep depression, I want to take my life. There is no hope.

[@amandajansen7697]

I am 43 and was diagnosed with FFA in 2013, after many years of unexplained hair loss. For the past 3 years, it has become extremely aggressive, even with the daily use of clobatisol foam. In 2013 the dermatologist took a piece of my scalp and sent it off to a "specialty lab" as I was told. As a woman, it's depressing to lose your hair. Society tends to accept it more in men than women. I'm shocked with the cost of wigs and how many insurances don't cover them as well as don't think of them as medically necessary. I live in NY and am very shocked that there are not any doctors researching this but instead throw you a script to be on your way. Thank you for this video. It's very very informative. I have multiple autoimmune diseases and experienced much trauma as well.

[@natureismylife5458]

I’m going through exactly the same. I’ve lost all my confidence due to this condition.

[@spbtch]

Me too. Started with eyebrows in early 40s.. then hairline at 45. No one in the UK has a clue how to deal with me. It’s frustrating as it’s very different to LLP. No gp has ever mentioned auto immune but I have had a lot of trauma and steer away from them trying to throw anti depression tablets bcz I’m not depressed! 😡

[@hydrangea8696]

@@spbtch I understand and am going through too xx

[@bellacella2444]

I first noticed symptoms after a some emotional trauma. For two weeks following the incident my body had felt like it had been in some type of accident. I was extremely fatigued and exhausted. First, I started losing my eyelashes then my brows. I shared this with family, nobody took it seriously. I’m not quite sure how long after but I noticed my hairline moving back, as a woman this was quite scary to me. Fortunately, my dermatologist was savvy and ordered blood tests and a biopsy right away. I was diagnosed with FFA, shortly after. I’ve been dealing with this auto immune disease for over a year now and can get it in remission. The disease has become pretty aggressive and it’s so depressing. They say stress triggers it. My dermatologist moved to Texas and my new Dr. wants me to take Hydroxychloroquine (I think) and I don’t feel comfortable taking that . Anyway, I’m happy to have found more info in this, I don’t feel so alone.

[@susieesquibel3096]

I am a 33 year old female and I just got confirmation of FFA from a scalp biopsy. I've always had fine eyebrow hair and I lost my eyebrows 10 years ago. Thankfully I have a good person who micro blades them, but other symptoms were texturing of the skin on forehead and changes in the hairline. I am doing as much research as possible before treatment. Results confirmed " mild nonspecific chronic inflammation" of the scalp. No redness only dry/scaly skin. Thank you Donovan for these informative videos, an updated one would be greatly appreciated.

[@donovanmedical9780]

thanks so much. This video is still up to date, but I'll add a new video in the future as things change. This is still very much current.

[@dinahsoar6982]

I finally got a diagnosis as to why I was losing my hair: FFA... It makes me mad that more than one physician 'pooh poohed' me...treated me like it was 'much ado about nothing'...blamed it on aging. It wasn't until I was referred to a dermatologist for another condition that I finally got a diagnosis. I"ve lost half of my eyebrows and between a half and one inch of my front hairline. It didn't happen over night either...the real kicker is that I had the same experience with breast cancer..another delayed diagnosis b/c the doctor blew me off..That was 30 years ago.. I'm here by the grace of God and being my own advocate. I can't help but wonder if the neglect is being driven by the bottom line, which is more important than the patient that is being treated.

[@annemartin7454]

You have explained to me exactly what my conditiomn is waiting long time for dermatologist appt; thank you.🙂

[@donovanmedical9780]

thank you. I am so glad this video could be of some help to you.

[@khha3797]

I don’t know what to tell you or how I can thank you for all those great info you are the best

[@cynthiaraftus7599]

I am 51 was also just diagnosed with FFA a month ago, it became very very aggressive in the last 3 years to the point I can tell the difference every time I get a shower. and also when mother nature started to go south in 2017, had to have a hysterectomy in 2020, I also have hypothyroidism (2011) , So I am triple cursed !!! LOL I am very pleased to hear this from a fellow Canadian !! I didn't want to believe that this was not reversible, but your explanation Donovan has finally hit home, I just wish it would hurry and stop falling out. Thank you very much for this

[@julesonthebeach777]

I think this may be what is causing my hair loss! It's kind of a relief. I have other autoimmune diseases as well. Thank you for this informative video!

[@fadihajjaj]

Very comprehensive lecture Thanks for the video

[@essanjay8604]

I have had FFA for 26 years (it was not diagnosed as such at the time). My hairline recession has been a lot slower than I anticipated but I'm now at the stage where I'd be happy to shave my head as it looks so terrible. Mine started with loss of hair from my limbs. Eyebrow loss has been a late development. At the same time I was diagnosed with Hashimotos disease and I react to spring sunshine and have hay fever. Mine all kicked off around age 40 (perimenopausal). I understand its a LOT more common now than it was 26 years ago!

[@essanjay8604]

I forgot to add I was also diagnosed with telogen effluvium at the same time as the FFA so I have ended up with receding straggly hair - lovely! It has taken 26 years though.

[@GrayWithMe]

This is a great lecture. I was recently diagnosed with lichen planopilaris, I have diffuse hair loss that seems to appear as androgenetic alopecia but with a chronically red scalp and pain when my hair moves around. These autoimmune diseases are very interesting.

[@donovanmedical9780]

Thank you for your comments. LPP is a great mimicker for sure. Yes, this pain when hair is moved is a frequent symptom. I wish you the best as you work toward stopping your LPP!

[@lizmilligan6177]

Thank you - I am a sufferer in the Uk - thanks to my consultant it was identified. I hope you continue to research this disease. Bit distressed to learn of impact on my skin potentially Thank you though - very informative.

[@essanjay8604]

I hope they are helping patients more these days - when I was diagnosed 26 years ago in the UK I was basically told to try Minoxidil but if it didn't work just get used to it - and then was discharged. FFA wasn't mentioned then - just told it was alopecia but I now know from photos this is what I have.

[@marwarashid105]

Which consultant did you see in the Uk?

[@hydrangea8696]

Which hospital were you seen in the uk

[@talinemerdkhanian1075]

Thank you Dr. Donovan for posting this very informative and well explained video. I haven’t been officially diagnosed with FFA, but I know I have it. I first started losing some of my eyebrow hair and then my sideburns are basically non existent and I have facial papules. I joined the UK FFA alopecia forum and to my surprise, I noticed that many women, including me have facial sweating and debilitating hot flushes. I have hypothyroid Hashimotos and also Primary Biliary Cholangitis. Both autoimmune diseases and I’m afraid to take any medications due to that autoimmune liver disease. Thank you for studying and addressing the dermatologists’ community about the FFA. I will be seeing a dermatologist in 2 weeks at USC Hospital in Los Angeles. Hope I can start with a treatment that is somewhat friendly to my liver. Thank you Dr. Donovan!

[@essanjay8604]

Can you give me a link to the UK FFA forum please. Many thanks. Interesting that several of us seem to also have Hashimotos!

[@donovanmedical9780]

Thanks for sharing Taline. Good luck with your visit in 2 weeks with the dermatologist.

[@julesonthebeach777]

​@@essanjay8604yes, fascinating! I have antibodies for Hashimoto's. I have Sjögren's as well as PMR.

[@guayaba2528]

Thank you for this very informative video. I was just diagnosed with FFA. My biopsy is in a month. After seeing your video I know that's what I have. (My doctor also asked me if I wanted the biopsy as an option) I think I should just forgo the biopsy and get right into treatment. Thank you, Jean Rodriguez

[@donovanmedical9780]

Thank you for this. Years ago, the main principle we taught junior doctors was "A biopsy is needed any time you suspect scarring alopecia." However, now with use of trichoscopy, I can confidently say those 'rules' and 'principles' are changing. There is nothing wrong with doing a biopsy in many cases, but it is often not necessary. Trichoscopy can guide the diagnosis a very long way.

[@arie1969]

I'm 32 and I just was diagnosed with FFA. I started to lose my hair about 10 months ago and BEFORE that (around 5 months earlier) I started to use SPF cream like CRAZY (4-5 times per day cause of sunny climate) and some of cream I've been putting occasionally on my hairline area time to time. And I wander did anyone else mention the same coincidence with using SPF cream and ended up with FFA?? Thank you for this video and your work, I hope you'll find a treatment soon!! This disease appeared out of nowhere and it's gonna literally ruin my entire life..

[@essanjay8604]

Kind of tricky if you need to use factor 50 due to bad reaction to the sun though!

[@E10l]

I’m 28 and have FFA. I was using sunscreen for years in large amounts. I regret it so much😭

[@marci8850]

I was using a moisturizer with sunscreen day and night. I didn’t know better. I feel like that had an impact with my ffa

[@ShyRage1]

Here's what I can say. Pre-2012, I was fine and had a remarkable hairline. After purchasing my home in 2013, I noticed a minor hair loss. Gradually, my beard and mustache area started to go first and the outside of my eyebrows. Then the sides of my head. I know for a fact. Pre 2012, I never used sunscreen. After 2012, I did because I worked in the oilfield. Not saying that it was the sunscreen. Heck, I could have picked it up in the oilfield. I also looked at old family photos and saw that one aunt seemed as though she had FFA. I have never plucked my eyebrows either. There is a limited amount of research on FFA, but the cases are growing.

[@garranard]

Have you had any success with research or treatment?

[@ShyRage1]

@@garranard not yet. I am still looking and researching. How bout you on you're end?

[@garranard]

@@ShyRage1 No success. Was on low dose doxycycline for 3 months, that reduced the scalp inflammation. Switched to 200mg Hydroxychloroquine, the scalp inflammation partially returned, notice some very slight almost negligible change such as ear hair and chest hair is stronger. Also have had some steroid scalp and eyebrow injection. No regrowth really of any note

[@suzettelawes2104]

Thanks for the information. I was diagnosed with FFA year. I noticed my hair falling out and the edges of my hair balding. In less than a month I lost my hair which became see through thin and continued to pop and shed. I noticed some growth without taking shots but I do take nutrafol. I have arthritis and I do sweat in my forehead alot. Thanks again.

[@stefanievandermeer2393]

I’m sorry are experiencing this. I have been going through something similar with losing my edges, followed by excessive/rapid thinning and shedding. By any chance we’re your eyebrows and eye lashes affected at the same time? As in all of this happened within a short time frame (it has been 2 months for me)

[@cynthiaraftus7599]

And....I have all the bodily hair losses, arms, legs, under arms and pubic, but it did start with my eyebrows, I just wish the dermatologist I went to when it started knew about this or thought of it, she just told me to condition, condition, condition and gave me a prescription for minoxidil

[@silversmith333]

After a miserable adolescence believing that my frontal hair loss was just mpb. I’ve finally come to the conclusion that this is ffa. The painful burning I felt when this started and the pale skin on my hairline are a give away. My forehead is shiny and I know the hair will never grow back. The hope I had for regrowth is gone. The follicles are completely dead and there’s no hope for regrowth. I’ve officially given up. I’m 18 and I can’t even remember the last time I was happy. This started for me when I just turned 14 and I see no reason to continue fighting on. I’ve been deeply depressed for years because of this and I know there’s nothing I can do, and nothing that will be done. I hate God for this. This is my final year.

[@taylorg.3070]

I'm praying for you! I'm very sorry that you're going through this and have had to deal with this condition for so long. Youre more than welcome to reach out to me if you need someone to listen to you!

[@jyothijoseph7447]

Nothing is impossible with God!

[@patricemoran7469]

As a senior citizen I'm dealing with sudden onset of alopecia areata...I'm praying for you Taylor...hopefully in time they'll find treatments for what you've had to deal with.

[@patricemoran7469]

I was actually commenting to Silversmith.

[@essanjay8604]

My best advice to you is to try and have some fun with wigs and other headgear. Develop your own style. Don't let your hairloss define you.

[@jeannelson-rodriguez1704]

Hi Dr. Donovan, I just watched your video with CARF. Thank you for your time, I always learn so much from your videos. I have a question, I had been diagnosed with hypothyroid since the '90's. After my diagnoses of FFA in October I decided to see a functional medicine doctor. She has diagnosed me with Hashimoto's. My question is - would my thyroid not being diagnosed properly for so long be a cause for my FFA? Or would FFA make a person with hypothyroidism turn into Hashi's?Orr. Jeff Dono

[@essanjay8604]

I think these autoimmune conditions (Hashis and Alopecia) tend to run in parallel unfortunately. Mine both started at the same time. What triggers it though that's the question?

[@joaovicentemarcal5887]

Congratulations Dr. Donovan! This was the most complete and enlightening presentation I have ever seen on the subject. Thank you for sharing. I'm a man, 56, fron Brazil. I was diagnosed with FFA and LPP. I have some doubts: 1) what is the recommended dosage for tacrolimus: 0.1 or 0.03%? How many times a day? 2) Are topical corticosteroids indicated? 3) What is the dosage of finasteride? 4) Is isotretinoin contraindicated for those who use rosuvastatin calcium 10mg? 5) For those who have already lost a lot of hair, would hair prosthesis be more suitable than implants? Thank you.

[@donovanmedical9780]

Often 0.1 % tacrolimus is used. How often one should use it depends on what other treatments they are using. It is used once per week by some and once daily by others. Topical steroids are often used. Again, they can thin the skin so proper monitoring is needed to ensure atrophy is not occuring. Finasteride is used at 1 mg in males who have no contraindications to the medication. If there are contraindications, it is not to be used. Isotretinoin can be used with rosuvastatin provided there are no contraindications to either drug. Monitoring for myopathy and other side effects is critical and the chance for this depends on the dose used. Prosthesis and transplants both have a role. A prosthesis can be added to the pan any time. A hair transplant can only be done once the disease has been quiet and inactive for 2 years as shown here: donovanmedical.com/hair-blog/ht-ffa

[@joaovicentemarcal5887]

Thank you very much for the prompt response and excellent professionalism, Dr. Donovan. I will look for more information on the website.

[@elchinn87]

Thank you...

[@Fly-uc3mo]

Happy I found you. Just had a biopsy done for this. The dr thinks it probably FFA. I have an appointment in two weeks for the results. My question is how often do you need to get the steroid injections done? Is it a series of a few then never again or every year? I do not have any shedding other then my front hair line so maybe I caught it early.

[@donovanmedical9780]

steroid injections are done every 6-12 weeks until the disease settles. that can be 6 months or a few years. If treatment with steroid injections is going to be needed for years, periodic breaks is helpful.

[@TheGalactica2001]

I was just recently diagnosed, but I think it all started years ago with small red scaling itchy patches on my scalp, never all over, just around the hairline. I had flares 2-4 times a year possibly around high stress times. I thought I had dandruff and tried every single shampoo on the planet, but nothing helped. Later I had to wear a mask for work all the time and thought my hair on the sides was falling out due to this. I wish I went to a dermatologist earlier. Luckily , my treatment currently works well, some hair has grown back.

[@donovanmedical9780]

thanks for sharing. I'm glad to hear that you have had some success.

[@hananfarag9349]

Could you please tell what treatment you are taking and give you good results ،?

[@kelseyirenemarkey]

what treatments did you try?

[@sherrylewis-rucker4478]

I have not been able to find a doctor in Pennsylvania that sees patients with FFA. The doctor that I approached in 2018 in the Philadelphia, PA conference only does research. If you have a colleague that specializes in hair loss, please refer me. Thank you.

[@ap3008]

My sister was diagnosed with hashimoto’s thyroid and I took a test as well and checked my thyroid. My thyroid levels are normal, but The endocrinologist discovered I was born with only half a thyroid and she said it was not a problem. What I observed though is both me and my sister have thinning of the hair especially in our more frontal area of the head, but not necessarily in this pattern that you are presenting. We are in our early 30s.

[@donovanmedical9780]

Thank you. One would need to examine the scalp to provide the diagnosis. 1 out of every 8 women in your age group have a diagnosis of androgenetic alopecia. Approximately 1 out of every 20,000 to 1 out of every 35,000 women in your age group have a diagnosis of FFA. Statistically speaking, a diagnosis of androgenetic alopecia would be far more likely for women in their early 30s than a diagnosis of FFA. But a proper examination, with trichoscopy, can resolve all doubts. Other diagnoses of frontal hair loss are also possible.

[@ap3008]

@@donovanmedical9780 Thank you very much for replying. A lot of women have androgenetic alopecia..wow.

[@itsagoodday2165]

Any correlation between endometriosis and this condition?

[@jillkreutzer4700]

I have white patches, blue veins in my forehead and what seems like black heads on my cheeks, also, thin eyebrows and very little body hair. Just got diagnosed and am shook by it. I also developed cataracts at the same time. Is there a connection?

[@buddycorlett]

Hey Donovan, great lecture...I am a 32 year old male with strong signs of FFA. I have diffuse hairloss all over my body including eyebrows and beard. I have begun a treatment of ketoconazole, topical minoxidl, as well as the pill form of minoxidl...and have a scheduled dermatological visit for a biopsy of the hair on my arms. I have two questions, first is would PRP hair treatment be something to consider for FFA?..and second is given that this is a rare condition in men, are there opportunities for experimental treatment? If it is possible to speak on the phone I would very much like that but as the life of a doctor is very busy I would understand if that is not possible. Thanks for the information.

[@donovanmedical9780]

PRP is not first line, no but sure it's an option if first line therapies fail. It's critical to get the correct diagnosis. For every 30 male patients who come to see me saying directly "Dr Donovan I think I have FFA" about 1 actually has the condition. The other 29 have something else. So first and foremost get the diagnosis. The scalp needs to be biopsied ideally. Few pathologist worldwide have really worked out consistently and definitively what a biopsy of FFA of the arm looks like and does not look like. Although it's rare in men, treatments are similar as women. Please contact my office for more information. They can tell you what is needed for a phone call discussion and if you would meet the criteria we have. We'll need photos, blood tests, biopsy results, questionnaire data, etc but yes, I do phone consultation every day with patients with complex hair loss conditions. [e-mail] takes you to my team.

[@jonessaetienne590]

You know whats crazy, I'm 28 now but I've had this condition since 21, started getting bald patches at 18 that eventually stopped growing back, it's very depressing, I don't like the way I look

[@TheZpad]

I wonder if HRT would help for those of us in Peri_menopause

[@underworldjack4877]

Hi Dr. Donovan, GREAT VIDEO! Thank you for posting. I am a 57 year old male and had a biopsy 6 months ago Confirming FFA. I noticed about 4 or 5 years ago my sideburns were disappearing along with my arm and leg hair. I have had problems with seborrheic dermatitis for a couple of years and had been to several dermatologists before i found one that diagnosed ffa. My hair loss wasvery gradual but i have last almost all of my sideburns...oddly my eyebrows are ok though. I have been using 100mg of doxycycline daily for about 5 months and the dermatitis and inflamation have cleared up. I have been using finasteride for about 15 years since I had a previous hair transplant. I am going to start using minoxidil with the hope I can get some hair back. My main question is regarding a transplant in the area. If my hairline stabilizes and the inflammation is under control, I realize the results may be mixed. My concern is that I am worried about stopping the doxycycline. Will it cause problems for my transplants if I am still taking doxycycline?

[@donovanmedical9780]

Transplants in FFA give mixed results as you say. The most important thing is to make sure it's very very very very very quiet before surgery and ideally that way for 2 years. Photos 2 years prior tot he surgery date must look identical to give the best chances of success and avoid flares and worsening of loss. But no, being on doxycycline does not harm the transplant or cause problems. it's something hundreds had done without issue. Of course, you'll want to speak to the surgeon doing the procedure as to whether stoppign a few days before and after makes sense or whether continuing makes sense. Doxy is not a problems and suboptimal results would not be likely from doxycycline at all.

[@underworldjack4877]

@@donovanmedical9780 Thank you! That is great to know. Is there a resource to find a dermatologist in my area that specializes in alopecia and hair issues?

[@michellescarborough16]

Dr. Donovan, I was diagnosed with FFA in 2017. It started with eyebrow hair loss. The dermatologist I saw had a horrible attitude towards my diagnosis. Basically. she said "Oh you have FFA and your going to lose your hair and it's never going to come back" I began to ask her questions . I am a registered nurse in Texas and I understand a lot of medical language. Never had I heard of this disease before. I don't have a good dermatologist who really understands this disease and can treat it properly. Basically, I end up educating my dermatologist! Can you make any recommendations on how to find a dermatologist who deals with this disease in Texas? One question I have is you say use steroid injections for hair loss in the eyebrows which are already scarred over and then a topical for hair regrowth? How is that possible?

[@donovanmedical9780]

If the eyebrows have some hair, and it's fairly early in the disease, steroid injections are worth considering. Some have regrowth to various degrees. This is both a hair loss condition and a scarring condition. We can see regrowth (sometimes) of the eyebrows with steroid injections and in some people the 5 alpha reductase inhibitors are promoting some degree of improvement as well. No, it's not complete. But gone are the days when we tell patents "it's impossible to get anything back." It's true that a lot of the time the best we can do is stop the disease but not always. Sometimes we see improvements and sometimes remarkable improvements.

[@michellescarborough16]

@@donovanmedical9780 Dr. Donovan, Thank you first of all for your informative video and your reply. Is there anything I can tell my dermatologist about what medicines she can prescribe to stop hair loss in eyebrows and eyelashes. I am also losing some eyelashes as well. I need to give her some good information as to a protocol of meds to use for both. I cannot take finasteride. My cardiologist says no. Also, how to treat my hairline as well. She does give me steroid injections in my frontal and above the ear hairline. My sideburn area is gone. My hair overall is thinning out. This is horrible to deal with for a woman. Any information will help tremendously. I appreciate your time and input. Thank you.

[@jet6110]

Do you have a website? I'm in Alberta and just discovered this is likely what I have. I have hashimotos/hypothyroid. I still have some eyebrow hair. I would love to be a patient of yours. My sister had it.

[@donovanmedical9780]

We are at donovanmedical.com

[@mashleyden]

I’ve been on the birth control Depo Provera for 5 years and have been experiencing this pattern of balding for the past year. I am in disbelief that my doctors cannot tie hair loss to hormonal changes caused my bc as something to potentially consider.

[@stefanievandermeer2393]

Hi Dr. Donovan, I can’t thank you enough for your content. I am a 41 y/o female and 2 months ago my hair started thinning excessively, followed by rapid hairline receding (leaving a white band) and bi-lateral eyebrow/eyelash loss. I am losing my eyelashes as well. I am experiencing burning/itching in the areas of hair loss. My hair and hairline seem to be disintegrating. I also notice hair loss behind my ears and at the back of my scalp as well in a band-like pattern, with itching present. I do not have visible red bumps/scales or facial papules but I do have visible veins and my side burns are still slightly present but have been affected. I am in the process of obtaining all of the tests required to request a consult at your clinic but after watching hours of your videos, I am concerned that if I do have FFS and it continues to progress this rapidly, it may leave me with a much more narrowed between diagnosis and treatment. With that being said, based on what I have mentioned - is there a chance it could not be FFS and possibly AA? Is there any chance it could be anything else with this type of pattern to the hair loss? My brows/lashes are most than 50% gone in 2 months. Is this indicative of FFS?

[@donovanmedical9780]

Thanks for the comment. Yes, there's always a chance it could be something else. Many hair loss conditions in women look pretty similar. You need a careful review of your entire story from birth until today, and a really careful scalp examination. This is the only way to get a diagnosis. Anything else typed here would just be a guess. All patients deserve a formal diagnosis so they can get started with the correct treatment - rather than just a best guess.

[@E10l]

Hi Dr Donovan I have a difficult question. if ones expreince worsening of inflammation in FFA on scalp,eyebrows,legs and arms after 4 months of taking plaquenil in maximal dose does it means its not going to help? I’m starting methotrexate tomorrow(keeping Finasteride and Prednisone) and I’m afraid its a mistake because plaquenil has more scientific research behind it 😢 right?

[@donovanmedical9780]

Be sure to review with your dermatologist. Plaquenil can take 6-9 months for maximal effects. No, the data is not really all that more solid Plaquenil than MTX. Data for both.

[@E10l]

@@donovanmedical9780 Thank you Dr Donovan🙏🏻My derm has more experience with plaquenil but the inflammation got to the point my face(eyebrows and and beard) burns so he decided to change to MTX.

[@shivampatel4461]

i am 21 years old male, i used minoxidil + finasteride solution and lost my hairline in a week of using it. i had mature hairline and i thought i was losing hair , shouldn't have done it . i thought it was shedding period and continued for 6 months with no visible regrowth, its now been 6 months since i stopped minoxidil in that time i had only little regrown on 1 temple. what should i do ? can minoxidil cause FFA ? i had itching from minox in the start as it was one of the side effects of minox.

[@shivampatel4461]

can i get FFA with irritation from minoxidil ?

[@user-iq8bs8ou2x]

Dr.jeff. i have DLE..how can i send you reports and pictures of hair loss.. because my doctor is skin specialist but he is not giving me steroid.. i want my hair back.

[@donovanmedical9780]

Thank you. Would you kindly contact my office and they can assist you in setting up an appointment with me. [e-mail]

[@chiarap5465]

I was diagnosed with alopecia areata incognito and aga, since a couple months i am losing eyebrows and my brows turned a sort of yellow color. My hairline has terribly receided and i have bumps on my forehead.I am 24. Could this be frontal fibrosing? I will try to book an appointment with you doctor, just worried about the waiting time. I am from Italy. Thank you for the video doctor.

[@donovanmedical9780]

Thank you for your comments. Up close examination is needed. Forehead bumps can occur in many conditions, including acne, alopecia aerate, frontal fibrosing alopecia, non hair loss related cysts and papules, folliculitis and many other causes.

[@chiarap5465]

@@donovanmedical9780 thank you so much for your kind reply Doctor Donovan ! I am considering coming to see you. I am from Italy. Kindest. Chiara

[@rosannemoore6841]

I have floroquinolone toxicity from taking cipro and levaquin for years. My last prescription put me in the hospital with hives all over my body and difficult breathing. After this episode my ffa began. These drugs began being prescribed in the late 80’s and 90’s and became the most highly prescribed antibiotics. My autoimmune blood tests are negative.

[@nazmussakib1405]

Hi. I'm Dr Nazmus Sakib from Bangladesh. 27 years old Male. Non diabetic, non Hypertensive. I have frontal fibrosing alopecia since 2011. I consulted many dermatologist and nothing works out. So wanted to transplant and they said it won't work. And now I'm facing alopecia in beard too. I'm confused tbh. I don't know what to do.

[@donovanmedical9780]

Thanks, you'll want to see a dermatologist to confirm the diagnosis as this would be unusual to start age 16-17 in a male. Make sure you're not missing another mimicking condition. But if it is FFA, there are goo treatments to consider including antiandrogens, retinoids, antihistamines, steroid injections and topical JAK inhibitors.

[@MrConhobar]

Hello doctor, i have a question and would greatly appreciate an answer to save me some nerves, i'm a 26 year old male with AGA (according to the dermatologist i visited, and according to my bald maternal grandfather who started losing his hair at about the same age :D (my miniaturized hairs are still there)) and i've experimented a bit with finasteride (which worked i think, hardly lost a hair during that time, but it made me depressed so i quit) and since then i think i am shedding more eyebrow hairs than i normaly would (we're talking 4-5-6 hairs per eyebrow on the worst days) some days 1-2, but they also seem to grow back in a normal time frame, i don't have any redness or itching or scaling on my brows, my question is this, with FFA, do the eyebrow hairs that are lost just fall out and then not regrow without treatment? Or do they fall out and regrow and fall out again until they eventually don't grow back anymore? I've chosen two hairs on the edge of my brow that i can clearly see to keep watch over, they fell out when this started, so 3 months ago, then a couple of days after they started growing again and those two are 100% still there and growing, now, 3 months later. I don't think i have any other symptoms, no papules, no pain in the scalp (occasional itching but i'm guessing it's normal given that it happens rarely and a good short scratch takes care of it), no pili torti, just some temporal recession with miniaturized hair still there and eyebrow shedding for the past 3 months (my eyebrows still look more or less the same as they did when it started). Thank you in advance if you manage to find the time to calm a guy losing his mind. I've accepted my fate of being bald, but i'd prefer to have eyebrows :D

[@donovanmedical9780]

Without treatment, it's not common for patients with FFA to have loss and then regrowth. It's usually a slow (or rapid) thinning. Usually it's quite slow but there's not a regrowth phase here. I don't know what's causing your issues as I would need to personally see your eyebrows up close and review your entire story. But the most common cause of eyebrow issues like this in males is seborrheic dermatitis followed by telogen effluvium. Your story would not be a typical story of FFA but of course the only way to confirm that with 900 % certainty is with a proper examation. However, I see a great number of patients including males with FFA and your story is not a typical story of a male with FFA. If your concerns persist, see a dermatologist. There are lots of good options for addressing eyebrow shedding but first we need to find the precise cause. Most likely if you have seb derm of the eyebrow you have seb derm on the scalp. Good luck

[@MrConhobar]

@@donovanmedical9780 You sir, are a nerve saver and i thank you for your fast response. I do have SD on my scalp, might be that it jumped over to my brows. I did also get covid 2 times this year (well, last year :D) during late summer (august) as a possible trigger for TE in October when this started. All the best to you and your patients.

[@drpaulcharlsonaestheticdoc8555]

Is there any suggestion that use of Sunscreen is actually linked to effect on Vitamin D production and deficiency?

[@donovanmedical9780]

Current evidence suggests that no - vitamin D production is NOT greatly affected by sunscreen use. pubmed.ncbi.nlm.nih.gov/30945275/

[@davidchudik5828]

Within two weeks of getting a hepatitis B vaccine, in September of 2018, my sideburns, eyebrows, and a lot of my temple hair fell off. I always had a good head of hair, so this was no coincidence. It was not a coincidence from all that I've read about vaccines and especially the hepatitis B vaccine. Much of the vaccine theories focus on alopecia areata but a biopsy was done and FFA was confirmed. Drug companies will do everything they can to suppress bad side effects. I wonder how many more nurses, teachers, therapists and other female-dominated professions have been requesting that their employees get vaccinated. I'm a male that got the hep-b vaccine but I know of a lot of women who had to get it for their jobs or sign a waiver.

[@ashnabasheer1022]

Hello doctor I would be so grateful if you would reply to my comment. I am a 23 year old female and my hairline has been slowly receding for the past 2-3 years since I had thick long hair I never actually paid attention to my hair loss. Now my eyebrows has started to fall at a very fast rate and they are also not growing back its mostly affecting both of my eyebrows in a similar way. I also had very thick bushy eyebrows so doctors just tend to ignore my concerns as they think I have more eyebrows than most of the people. I also have noticed very very fine hardly noticeable hairs on my comb and I have hairs of varying thickness. I just feel like I have FFA and I don't know what to do about it.

[@donovanmedical9780]

I would need to see your scalp up close and know more about your story to help you determine what diagnosis you have and how to treat it. I would suggest that you see a specialist in scarring alopecia in your area if you are worried about FFA being a possibility. You need a proper consultation including a full review of your story and up close examination. It's not common for a 23 year old to have FFA (but not impossible of course). But what you need is a proper examination.

[@ashnabasheer1022]

@@donovanmedical9780 Thank you so much for replying doc. I have been trying to find a doctor specialising in scarring alopecia but its so hard to find one. I live in Dubai, is there any doc you could refer me to either in the UAE or India?

[@ShyRage1]

I'm a guy who has lynching Plano perilous and FFA. All this talk about menopause and thyroid problems and all that goes out the window because I have none of that. I never use botox in my life

[@armymatters8042]

I believe hair dyes can trigger this.

[@cynthiaraftus7599]

the treatment my dermatologist of antibiotics didnt work and continues to fall out :(:(:(:(

[@donovanmedical9780]

You'll want to discuss with your dermatologist the first, second and third line options and decide what is right for you. Be sure to watch starting at 59:40. There are many good options for FFA.