Redness around hair follicles: What does in mean in frontal fibrosing alopecia (FFA)?

Perifollicular Redness in FFA

Frontal fibrosing alopecia or "FFA" is a scarring alopecia (scarring the of hair loss condition) that most commonly develops in perimenopausal and post menopausal women.

It causes permanent hair loss.The condition usually has no symptoms  - and many patients have no itching, burning or pain.

How do we know whether a given patient's FFA is active?

The best way to determine activity is with a photo. If a patient's photo changes over a period of monitoring (6 months or 12 months) the FFA is active definition. However, photographs don't capture subtle changes in activity.

Dermoscopy for FFA

To accomplish the goal of monitoring subtle changes at any given time,  examination by "dermoscopy" is helpful. In this photo, slight redness around the hairs can be seen. We call this "perifollicular" erythema. (the word "peri" simply means "around").

In 2013, Spanish researchers Toledo- Pastrana and colleagues published an article in the International Journal of Trichology examining dematoscopic features of women with frontal fibrosing alopecia. Of 79 individuals were examined, 66 % showed perifollicular erythema. In those with active disease, perifollicular erythema was present in 95 % of patients.


Redness around hair follicles is an important sign to look for in FFA. It indicates disease activity and a high likelihood of further hair loss in the patient.




Toledo- Pastrana et al. Perifollicular erythema as a trichoscopy sign of progression in frontal fibrosing alopecia. Int J Trichoscopy 2013; 5: 151-3.

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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