Female Hair loss: Frontal Hairline

Female pattern hair loss is the most common cause of hair loss in women, and it increases with age. In general, the frontal hairline is not affected, it starts at the crown and is limited to 1 - 3 centimeters behind the front of the hairline. In some advanced cases, it is possible to lose hair towards the front of the head, this is known as a frontal anterior recession.

In today's society men are expected to have these problems, however, women struggle far more with its symptoms. They often feel ashamed and limit themselves socially, they may suffer from low self-esteem as a result. Treatment options sometimes take a long time to work, and many ladies seek the help of their doctor to find a solution.

Female pattern hair loss Stages

Female pattern hair loss starts in the center of the scalp, the anterior (front part) is usually not affected during early stages. It will also be more noticeable when you part your hair in the middle. Thinning can occur right after puberty or the first occurrence of menstruation, women may notice more hair in the drain, but it will not be substantial enough to notice any change in volume.

Some women may notice progressive thinning on the bitemporal region (sides of the scalp), a scalp biopsy can be taken to check if there are fewer hair follicles in the area. The central parting on the scalp will widen in some women, in more extreme cases there is further thinning around the central part, which may spread over the entire area. Some women may notice thinning at the front part of the hair-line, but generally, hair loss does not occur.

The stages of hair loss are classified using different scales, we use the Savin density scale, or the Ludwig scale which is listed below:

Stage I-2
This stage starts with thinning at the center of the scalp, generally where the hair parts, women might notice more hair falling out, but not enough to cause bald spots. The image below shows an illustration

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Stage I-4
This stage leads to further thinning along the central crown, you may notice more hair coming out periodically, as well as more diffuse hair loss.

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Stage II-2
This will lead to hair thinning, and loss of thickness near the crowns, at this stage many woman become alarmed and seek medical advise. There are also signs of balding along crest, as shown in the image below.
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This is one of the final stages, more hair has been lost, and a prominent bald spot can be noticed.
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Fontal anterior Recession.
This can result in progressive thinning of the frontal hairline, even though this is more common in men, the female version is known as frontal anterior recession, it is usually known as traction alopecia which is caused by tight fitting hairstyles like dreadlocks, braids or pony-tails. It can also be related to using chemicals or too much heat on your hair. The image below shows the original hairline which was reduced by about 1 centimeter due to recession.

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Signs of Traction alopecia

There are some symptoms that doctors look for when it comes to traction alopecia, they include:
  • Receding hairline: A receding hair-line at the front, or sides of the head
  • Pimples: You may have small pimples develop on the scalp
  • Redness and Itching: It is common to have bumps, tenderness in the area
  • Inflammation: there may be inflammation in the hair follicles

What is Frontal Fibrosing Alopecia?

Another possible cause of a receding hairline is Fibrosing alopecia, this is a form of scarring alopecia which is caused by inflammation of the hair follicles. These become destroyed and are replaced with scar tissue which inhibits hair growth in the area. Scaring can usually occur near the forehead which encounters progressive hair loss over time.

The exact cause of this condition is unknown, it is linked to autoimmune diseases which can attack the hair follicles, it generally affects women over the age of 45.

Can frontal fibrosing alopecia be cured?

Although there is no cure, anti-inflammatory medicine is often the best option, these can stop the bodies immune system from attacking the hair follicles. Men are known to use Finasteride to block the production of male hormones, and some women have also seen positive results from using this medication. Some topical corticosteroids creams can help stop hair loss, other medications are able to suppress the immune system from causing more damage to the hair follicle.


For many women, frontal hair loss is alarming, it is strongly advised to wear loose-fitting hairstyles, avoid braids and dreadlocks since these are known to cause receding hairlines. If you are uncertain what could be causing your problem, visit your physician to get an accurate diagnosis. Any condition that causes hair loss can be problematic and stressful and should be dealt with accordingly.


A young woman with bitemporal hair loss

Female pattern hair loss: Current treatment concepts

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