Initially, it’s subtle. Then, one night your hair is in all the right places but when you wake up in the morning it has changed. It’s thinning. But wait, it’s actually worse than you thought because the thinning is in the most noticeable area - the edges! My patients frequently describe their hair loss experience exactly like this. Thinning around the frontotemporal hairline, an area known by many as, “the edges”, is extremely common and a huge source of angst for men and women but the effect it has on women is unique. In this piece, I will review some common causes of hair thinning on the frontal hairline along with suggestions to treat and prevent it.
First, the most common type of hair loss is caused by advancing age, hormones, and heredity, and is called androgenetic alopecia. This is a normal physiologic change that occurs in some men and women because of a sensitivity of the hair follicles to testosterone which causes the hairs to become thinner, finer and lighter. In women, this natural type of hair loss affects the vertex (top) of the scalp with the frontal hairline (edges) remaining intact. In men, the hair loss pattern typically occurs on the frontotemporal hairline and causes it to recede, as well as the vertex.
Women also experience frontotemporal hairline thinning. The most common diagnoses associated with this type of hair loss in women is traction alopecia, frontal fibrosing alopecia, telogen effluvium, and less common causes like various autoimmune conditions, temporal triangular alopecia, and others. It’s important to note that many of these conditions can occur in combination, and often are exacerbated by medications or other stressors.
Traction alopecia is the most famous cause of hair loss near the temples, particularly among individuals who wear their hair in tight styles or fixed positions for long periods. Ponytails, braids, weaves or even aggressive brushing may contribute to this condition. It may affect the very young and often begins in childhood. So, the basic issue here is prevention at an early stage. Try varying your style more often and don’t pull the hair very tightly! If you suddenly notice thinning after a particular style, remember it and don’t go back to it. Any hairstyle that hurts is placing those hair follicles at risk for inflammation and loss. If you are responsible for styling a child’s hair, ask them if it hurts and if it does, loosen the style until it does not. There are new products on the market that contain natural oils and ingredients which are intended to stimulate hair regrowth. However, without clinical studies, it’s hard to know if they really work but lots of reviews online indicate that they can be helpful. In my opinion, if these products drive you to moisturize and care for your hair and scalp in a gentle way that feels good to you, it’s a win.
Frontal fibrosing alopecia (FFA) is a condition that I am seeing more often now than ever before. I want to stress that early detection of this condition is absolutely critical because this type of hair loss causes progressive scarring and irreversible alopecia. FFA is a subtype of lichen planopilaris, a condition affecting the hair follicles because of an inflammatory disorder. This inflammation is caused by the absence of normal protection afforded to the hair follicle region called the bulge, where the hair follicle stem cells are located. Many of us mischaracterize this type of hair loss as typical traction alopecia, but there are some differences so here’s what to look for:
- First, hair follicles are surrounded by swelling and redness at the scalp. This is visual evidence of inflammation and causes hairs to look like they are standing up straighter at the root, like “doll’s hair.”
- As it progresses, one may notice that the hairline is shiny with a half-inch of a band of alopecia across the front, and if you pay attention or compare photos, you will be able to tell that this extension of the forehead skin was not always there and that it is truly exposed scalp with hair loss. There may be a “lonely hair” sign present – one or two solo hairs in the center of this exposed scalp.
These features are tough to determine on your own, so be sure that if you notice changes along the hairline, see a board-certified dermatologist who treats hair disorders early. is a condition that must be managed early. Researchers are actively engaged in defining the genetic associations related to this and other hair disorders. However, for now, dermatologists may prescribe medications or use injections to treat FFA after the diagnosis has been established. Feel free to direct message me @livsolife directly if you have any questions about the medications.
Telogen effluvium (TE) is another condition that may be associated with thinning of the edges. Most people notice hair shedding from all over the scalp, but there may be one area or another where individuals find that the hair looks thinner. Often the frontal hairline is noticeable because it is, well, in the front. Also, the front hairline frames the face so that we notice it easily. Typical causes of TE include postpartum hair shedding, anemia, thyroid disease, stress, post-surgical/trauma, or medication side effect. The most important thing to do is to establish the diagnosis, and localize the underlying cause to remedy it directly. In an ideal situation, this will cause the condition to improve. In real life, it may require the help of topical minoxidil, vitamins, or even novel therapies like platelet-rich plasma injections to help stop hair loss.
Temporal triangular alopecia is a much less common condition, which typically affects children but may also appear in adulthood. This condition is non-scarring, but is persistent and is often misdiagnosed as alopecia areata that is close to the frontal hairline. Again, the diagnosis is key. Sadly, treatment is not very effective.
So, what should you do and expect when you begin to see early signs of hair thinning along the edges? I recommend seeing your dermatologist as soon as possible to get a proper diagnosis. Expect that if they cannot make a diagnosis with certainty based on your history and exam, a scalp biopsy may be suggested. This will enable a dermatopathologist to look at your scalp under the microscope and help determine the type of hair loss that you have with more accuracy. In the meantime, wear your hair in gentle styles, working with your stylist to establish a care routine focused on camouflage without tension. At home, practice self-care on a regular basis with scalp and hair cleansing and conditioning habits that are soothing and sustainable. We hope that LivSo will be helpful here. Perhaps most importantly, consider that this may be a long-term issue although we hope that it improves sooner rather than later. The honest fact is that it may not remedy itself quickly, and it will be frustrating if you expect a sudden turnaround. With this in mind, the most important advice is to be as kind to yourself through the process as you would want others to be to you.
Live free and clear,
Shari