Healthy hair
The midlife hair loss concern affecting more women than ever
Along with night sweats, low mood, and vaginal dryness, a common symptom of menopause is hair loss – over half of women in their midlife years (and beyond) experience this issue.
In many instances, hair will regrow to some extent. However, there’s one menopausal scalp concern that causes irreversible hair loss, and it’s becoming more common: frontal fibrosing alopecia (FFA).
What is frontal fibrosing alopecia?
There are two types of alopecia, non-scarring and scarring. Whereas the more common types of alopecia, such as androgenetic, are non-scarring, FFA is of the scarring variety.
“FFA occurs when the autoimmune system mistakenly sees the growing unit of the hair, called the pilosebaceous unit, as a foreign object,” explains Eva Proudman, consultant trichologist, FIT, IAT, of UK Hair Consultants. “It destroys it underneath the scalp and seals over the follicle.”
While FFA begins with hair loss at the top of the forehead and around the ears, it can progress to as far back as the crown. The condition can also affect the brows, lashes, and other body hair. Additional symptoms of FFA include redness, inflammation, and itching.
There’s no set timeline for FFA hair loss, says Eva. It can remain in the hairline for years in some patients, while others notice it galloping away after just a couple of months. “If it feels or looks like it’s receding, if the skin feels smooth, or you’ve got intense itching, go and see somebody,” she advises.
Timely detection and treatment of FFA is crucial, states trichologist Natalia Souza. “FFA is a scarring form of alopecia, meaning that once the hair follicles are damaged, they cannot regenerate,” she says. “Early treatment can help slow or stop the progression of follicular destruction, reduce inflammation, and preserve the remaining hair.”
What causes frontal fibrosing alopecia?
We don’t yet fully understand the exact causes of FFA. Experts believe that a variety of factors, often in combination, may contribute to the condition’s development.
Hormone levels
FFA is most commonly seen among post-menopausal women.
“Hormonal changes, particularly a decline in estrogen, are thought to play a significant role,” says Natalia. “This hormonal shift may trigger immune responses that target hair follicles.”
However, research shows that cases are rising among pre-menopausal women (and men). Scientists are now exploring the potential role of other hormones, such as androgens, in FFA.
Emotional stress
High levels of stress and depression are a classic trigger for FFA, explains Eva. With up to 50% of peri- and post-menopausal women experiencing psychological and emotional symptoms, it’s understandable why FFA is more prevalent among midlife women.
Genetics
Studies show that FFA may have a genetic component. “You can be more susceptible to it if you have autoimmune conditions in your family,” adds Eva. “For instance, rheumatoid arthritis, diabetes, and thyroidism – all of those things can predispose you to be more likely to develop FFA.”
Vitamin D deficiency
Low vitamin D levels (a particular concern in post-menopausal women) have been associated with FFA, with studies finding that deficiency is more common among women with this type of alopecia.
Why the rise?
Previously, Eva only saw a few patients a year with FFA; now, she treats a couple of patients with the condition each week. So what’s led to such an increase? A few key factors have likely come into play. People are now more willing to explore problems they’re experiencing with their tresses – with looking after the scalp and hair viewed as a wellbeing issue rather than one of vanity.
In addition, advances in dermatology have enhanced recognition of FFA, leading to more diagnoses. Awareness among GPs has also significantly improved, as trichologists have worked to educate them on the differences between FFA and female pattern baldness.
Treating frontal fibrosing alopecia
Unfortunately, there’s no cure for FFA – but various interventions and approaches can aid in stabilising and managing the concern to prevent further hair loss.
Natalia says that topical medications, such as corticosteroids or calcineurin inhibitors, are commonly prescribed to help reduce inflammation in the affected area of the scalp.
Oral drugs may also be prescribed, often in combination with a topical treatment. For instance, finasteride or dutasteride target androgen levels, says Natalia. For more severe cases of FFA, Eva explains that hydroxychloroquine or methotrexate may be given to help reduce inflammation. However, these drugs have the potential for side effects on eyesight and liver function, respectively. Baseline testing and monitoring are conducted to check for any negative impacts.
The length of time that patients need medication varies widely, says Eva. Some may respond quickly and only require them for a few months, while others take them for a year or longer.
Alternative options
For those desiring a less intensive route, there are also options that don’t require a prescription.
“I have a treatment called Trichotide Plus, which is a combination of the amino acid tyrosine and a specific dose of vitamin D,” reveals Eva. “Those two combined are incredibly good at reducing inflammation in the skin, particularly the follicle. I’ve seen really good results with it.” Patients are typically given this treatment for three months, then reassessed to check for progress. Unfortunately, it’s unsuitable for those taking antidepressants or thyroid medication.
Natalia also uses a combination approach, comprising an anti-inflammatory food plan alongside E50 Exosomes treatments. “These strategies work synergistically to address the root causes of inflammation, promote scalp health, and potentially minimise the progression of the condition,” she reveals. A course of E50 Exosomes treatments is recommended.
“Many patients notice a reduction in scalp inflammation after the first session,” Natalia adds – and platelet-rich plasma therapy can further enhance results. Whatever treatment approach you choose, it’s important to understand that results can vary between patients.
If noticeable hair loss has occurred, Eva reveals that ‘frontals’ are a nifty solution to cover things up. These small fringe-like attachments (such as those by Mandeville London) are custom-made to fit perfectly in the affected area and match the colour, weight, texture, and pattern of your remaining hair. “You put them on in the morning, take them off in the evening, and nobody would know you were wearing one,” Eva assures. “They’re really clever.”
Words: Chantelle Pattemore
