Hydroxychloroquine achieves disease stabilization in approximately 70% of frontal fibrosing alopecia patients, making it the most commonly prescribed first-line systemic treatment for this progressive scarring condition. Because FFA causes gradual, permanent recession of the frontal hairline, tracking whether hydroxychloroquine is actually halting that recession is the single most important step you can take after starting treatment.
This article is for informational purposes only and does not constitute medical advice.
Understanding Frontal Fibrosing Alopecia
Frontal fibrosing alopecia is a form of scarring alopecia closely related to lichen planopilaris. It predominantly affects postmenopausal women (though premenopausal women and men can also develop it) and causes a slow, progressive recession of the frontal hairline and temples. Eyebrow loss is common and often precedes noticeable scalp hairline changes.
Why Hydroxychloroquine Is First-Line
Hydroxychloroquine is an antimalarial medication with immunomodulatory and anti-inflammatory properties. It reduces the lymphocytic inflammation that drives follicle destruction in FFA. It is well-tolerated by most patients, has a long safety track record, and is relatively affordable compared to other immunomodulatory treatments. Most dermatologists prescribe hydroxychloroquine as the first systemic medication for FFA.
Dosing
The typical dose is 200 to 400mg daily (usually 200mg twice daily or 400mg once daily). Dosing is based on body weight, with a maximum recommended dose of 5mg per kilogram of actual body weight to minimize the risk of retinal toxicity.
The Hairline Position Measurement Protocol
FFA tracking differs from most other hair loss conditions because the primary metric is hairline position rather than overall density.
Step 1: Establish Fixed Reference Points
Choose three consistent measurement points across your forehead:
| Point | Location | How to Measure |
|---|---|---|
| Center | Middle of forehead | Distance from mid-glabella (between eyebrows) to hairline |
| Left temple | Left temporal hairline | Distance from outer corner of left eye to temporal hairline |
| Right temple | Right temporal hairline | Distance from outer corner of right eye to temporal hairline |
Use a small ruler or measuring tape held flat against the skin. Record measurements in millimeters for maximum precision.
Step 2: Standardize Your Photo Protocol
For each tracking session, take the following:
- Frontal view: Face the camera directly with your forehead fully exposed, hair pulled back
- Hairline close-up: Camera 8 to 10 inches from forehead, with a ruler visible in frame for scale
- Left temple view: Profile shot showing temporal hairline recession
- Right temple view: Profile shot showing temporal hairline recession
- Overhead view: Part your hair to show the frontal zone density
Use the same lighting, camera, and distance each time. Natural daylight near a window provides the most consistent results.
Step 3: Upload for AI Density Analysis
Upload your photos to myhairline.ai/analyze to get objective density measurements for your frontal zone. While hairline position is the primary metric in FFA, density measurements in the zone just behind the advancing front of recession can detect subclinical thinning before visible hairline change occurs.
Tracking Schedule
| Period | Frequency | Focus |
|---|---|---|
| Months 0-3 | Every 4 weeks | Baseline, await drug onset |
| Months 3-6 | Every 4-6 weeks | Early stabilization assessment |
| Months 6-12 | Every 6-8 weeks | Confirm sustained stabilization |
| Beyond 12 months | Every 8-12 weeks | Long-term monitoring |
Hydroxychloroquine takes 2 to 3 months to reach full effect, so the first 8 to 12 weeks of tracking primarily confirm your baseline rather than showing treatment response.
Defining Stabilization Success
In FFA, treatment success means stopping progression. This is a different goal from conditions where regrowth is expected.
Successful Stabilization Looks Like
- Hairline measurements stable within 1 to 2mm over 6 or more months
- Reduced or absent perifollicular erythema at the hairline edge
- Decreased symptoms (itching, tightness, burning at the hairline)
- Stable AI density readings in the frontal zone over consecutive sessions
- Stable or improved eyebrow density (if eyebrows were affected)
Signs That Hydroxychloroquine May Not Be Adequate
- Hairline measurements showing continued recession (more than 2mm over 6 months)
- Persistent perifollicular erythema and scale at the hairline margin
- Ongoing symptoms despite 6 or more months of treatment
- Declining AI density in the frontal zone
If your tracking data shows continued progression, your dermatologist may increase the dose (if not already at the weight-based maximum), add an adjunctive treatment (topical corticosteroids, minoxidil, intralesional injections), or switch to a second-line systemic agent (methotrexate, mycophenolate mofetil). For a comprehensive FFA-specific tracking guide, see frontal fibrosing alopecia tracking.
Tracking Eyebrow Involvement
Eyebrow loss affects the majority of FFA patients and is an important aspect of disease monitoring. At each tracking session, take close-up photos of both eyebrows under consistent lighting. Note the pattern (lateral thinning is most common), density, and any new loss. Eyebrow stabilization on hydroxychloroquine is a positive indicator of overall disease control.
Eye Exam Monitoring
Hydroxychloroquine carries a small but serious risk of retinal toxicity with long-term use. Current guidelines recommend a baseline ophthalmology exam within the first year of starting treatment, followed by annual screening after 5 years of use (or sooner if you have risk factors such as kidney disease or higher doses).
What to Record
Keep a log of your ophthalmology visits alongside your hair tracking data:
| Eye Exam Data | When |
|---|---|
| Baseline exam | Within first year of treatment |
| Annual screening | After 5 years of use (annually) |
| OCT results | Recorded at each exam |
| Visual field testing | Recorded at each exam |
| Any findings | Note immediately |
This record ensures continuity of care, especially if you see multiple physicians. For detailed tips on preparing medical documentation, see how to document hair loss for your dermatologist.
Preparing for Dermatology Appointments
Before each follow-up visit, compile your hairline measurement log showing trends at all three reference points, your photo timeline (most recent alongside baseline), AI density trend data for the frontal zone, your symptom log, and your most recent ophthalmology report. This package allows your dermatologist to make a confident assessment of treatment response in the limited time available during an appointment.
Long-Term Considerations
FFA is a chronic condition, and hydroxychloroquine treatment is typically continued for years. Your tracking data over the first 6 to 12 months determines whether hydroxychloroquine is your long-term maintenance medication or whether additional or alternative treatments are needed. Consistent documentation over months and years builds the most reliable picture of disease behavior in your specific case.
Start Measuring Today
If you have been prescribed hydroxychloroquine for FFA, begin your measurement protocol now. Upload your frontal hairline photos to myhairline.ai/analyze to establish your objective density baseline, take your three-point hairline measurements, and start building the record that will show you and your physician exactly how well your treatment is working.
This article is for informational purposes only and does not constitute medical advice. Frontal fibrosing alopecia requires diagnosis and management by a qualified dermatologist. Always consult your physician before starting or changing any treatment.