Hair Transplantation in Frontal Fibrosing Alopecia

Hair transplants for FFA

Frontal  Fibrosing Alopecia is a cause of permanent scarring hair loss fibrosing alopecia is a  rare scarring hair loss condition that affects the frontal scalp. The condition occurs mostly in women although men can very rarely be affected. Frontal fibrosing alopecia causes permanent hair loss. Treatments for the condition include topical steroids and non-steroid medicines, steroid injections, as well as oral medications such as tetracyclines, hydroxychloroquine, mycophenolate mofetil and cyclosporine.


Patients with frontal fibrosing alopecia often ask me  - Is it possible to have a hair transplant?

To answer this question,  I remind myself of a interesting research study from Drs. Nusbaum and Nusbaum in Miami, Florida which was published in the journal Dermatologic Surgery.

Nusbaum BP and Nusbaum AG. Frontal fibrosing alopecia in a man: results of follicular unit test grafting. Dermatol Surg 2010; 36: 959-62.

In the journal, the doctors report a 44 year old man with frontal fibrosing alopecia who underwent a hair transplant.  Prior to the hair transplant he was treated with topical steroids and steroid injections. He also used the oral medicine hydroxychloroquine for 6 months.  His disease appeared to be ‘quiet.’

With the disease quiet, the man stopped the medications and underwent a very small ‘test’ hair transplant with 82 follicular units placed into the scalp.  Three months after the transplant, the hair started to grow and after 15 months after the transplant the hair had grown in normally. This would have been tremendously exciting for both the patient and surgeon.  Four years later, however, only 6 hairs remained – the remaining hairs were destroyed by the scarring alopecia. 


Comment: This report is very important. It reminds us of just how complex the disease frontal fibrosing alopecia can be. The disease can appear quiet for extended periods and then can reactivate.  It is challenging for doctors to monitor because patients often have no symptoms. 

We still can’t predict with certainty if a hair transplant will be successful in a patient with frontal fibrosing alopecia. Sometimes it can be - but sometimes it won't. The above study reminds us that hairs can grow in nicely, only to be lost in future years.  Further studies are needed to determine if patients who receive treatment with topical and oral medicines are less likely to lose their hair.

Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Whistler office at 604.283.1887

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