Frontal Fibrosing Alopecia (FFA): Treatment Options Ranked

Frontal fibrosing alopecia (FFA) is a scarring hair loss condition with no cure, but several treatments can slow or halt its progression when started early. Misdiagnosis of hair loss type leads to incorrect treatment in roughly 28% of cases, so confirming FFA through biopsy before starting any therapy is critical.

This content is for informational purposes only and does not constitute medical advice. Consult a board-certified dermatologist experienced in scarring alopecias before starting treatment.

How FFA Treatments Are Ranked

The treatments below are ranked by the strength of published clinical evidence and reported patient outcomes. No single therapy works for every patient, and most dermatologists combine two or more approaches. The goal of all FFA treatment is to stop progression, not to regrow hair in already-scarred areas.

1. 5-Alpha Reductase Inhibitors (First-Line)

Finasteride (1 mg daily) and dutasteride (0.5 mg daily) are the most widely used first-line treatments for FFA. These medications block the conversion of testosterone to dihydrotestosterone (DHT), and multiple case series report stabilization in 50% to 90% of patients.

Dutasteride inhibits both type I and type II 5-alpha reductase enzymes, while finasteride targets only type II. This broader mechanism may explain the slightly higher response rates observed in some FFA studies.

Note: Dutasteride is FDA-approved for benign prostatic hyperplasia, not hair loss. Its use for FFA is off-label.

2. Hydroxychloroquine (First-Line)

Hydroxychloroquine is an antimalarial drug with anti-inflammatory properties that has become a standard FFA treatment. It works by modulating the immune response that drives follicular destruction. Typical dosing is 200 to 400 mg daily.

Published studies report stabilization in approximately 50% to 70% of FFA patients. Regular eye examinations (every 6 to 12 months) are required because long-term use carries a small risk of retinal toxicity.

Many dermatologists combine hydroxychloroquine with a 5-alpha reductase inhibitor as a dual first-line approach.

3. Topical and Intralesional Corticosteroids (Adjunctive)

Topical corticosteroids (clobetasol propionate 0.05%) applied to the frontal hairline can reduce local inflammation. Intralesional triamcinolone injections (2.5 to 10 mg/mL) directly into the advancing edge of FFA provide more targeted anti-inflammatory effects.

Corticosteroids are rarely used alone. They work best as add-on therapy alongside systemic medications. Side effects include scalp atrophy with prolonged topical use and temporary skin depression at injection sites.

4. Topical Calcineurin Inhibitors (Adjunctive)

Tacrolimus (0.1%) and pimecrolimus (1%) ointments are topical immunosuppressants that can reduce perifollicular inflammation without the skin-thinning effects of corticosteroids. They are applied directly to the affected hairline area once or twice daily.

Evidence for calcineurin inhibitors in FFA comes primarily from small case series, but they offer a steroid-sparing alternative for long-term maintenance therapy.

5. Minoxidil (Supportive)

Topical minoxidil (5% solution or foam) does not treat the underlying autoimmune process of FFA. However, it can improve the appearance of non-scarred areas where follicles are miniaturized but not yet destroyed. Minoxidil produces moderate regrowth in 40% to 60% of users with standard pattern hair loss and may help preserve density at the edges of FFA-affected zones.

Apply twice daily to areas where some follicular activity remains. Do not expect regrowth in fully scarred areas.

6. Platelet-Rich Plasma (PRP) Therapy (Emerging)

PRP therapy involves injecting concentrated platelets from your own blood into the scalp to stimulate healing and reduce inflammation. Sessions cost $500 to $2,000 each, with 3 to 4 initial sessions recommended at 4 to 6 week intervals.

Evidence for PRP in FFA is limited to small studies and case reports. Some dermatologists report reduced inflammation at the active edge of FFA, but larger controlled trials are needed before PRP can be considered a standard treatment for this condition.

7. Hair Transplant Surgery (Conditional)

Hair transplant is only appropriate after FFA has been confirmed inactive for at least 12 to 24 months through stable clinical photos and a clean biopsy. FUE (Follicular Unit Extraction) is the most common technique, with a recovery time of 7 to 10 days and standard graft survival rates of 90% to 95% in healthy scalps.

In FFA patients, graft survival drops to 50% to 85% depending on disease stability. Costs range from $4 to $6 per graft in the USA and $1 to $2 per graft in Turkey. For a full assessment of candidacy, see our hair transplant candidacy guide.

8. Camouflage and Cosmetic Options (Immediate)

While medical treatments work to stabilize FFA, cosmetic solutions provide immediate visual improvement:

• Scalp micropigmentation: Tattooed pigment dots that simulate follicular density
• Hair fibers: Keratin-based fibers that cling to existing hair to fill thinning areas
• Hairpieces and toppers: Custom-fit coverage for the frontal zone
• Strategic hairstyling: Forward-swept styles that minimize visible recession

These options carry no medical risk and can be combined with any active treatment.

Building a Treatment Plan

Most successful FFA management combines multiple approaches:

1. Confirm diagnosis with scalp biopsy and dermoscopy
2. Start a 5-alpha reductase inhibitor plus hydroxychloroquine
3. Add topical corticosteroid or calcineurin inhibitor to the active edge
4. Monitor with serial photography and dermoscopy every 3 to 6 months
5. Consider PRP or transplant only after documented stability

For a complete overview of FFA, read our frontal fibrosing alopecia overview. If you are unsure whether your hair loss is FFA or another pattern, get a free AI analysis at myhairline.ai/analyze to assess your current stage and guide your next consultation with a specialist.