Higher forehead: normal or worth checking?

"My forehead looks bigger." Many people notice this in a photograph, with a new haircut or because someone comments. In some cases it is just the natural shape of the hairline, which has always been high, or the mature line that forms after adolescence. In others, the front hairline really is receding, and the cause matters a great deal.

There is one cause in particular that should not wait: frontal fibrosing alopecia. It is a scarring alopecia, increasingly diagnosed, especially in women after the menopause, in which lost hair does not grow back. It often starts with the eyebrows. Recognising it early makes it possible to halt its progression.

High forehead, mature line or true recession?

High forehead from birth

Forehead height and the shape of the hairline are, to a large extent, hereditary. Some people have had a high hairline since childhood. If the shape is the same as in old photographs, there is no recession.

Mature hairline

After puberty, the hairline rises slightly, especially at the temples, in almost all men and in many women (Hamilton, 1951). It stabilises in early adulthood. See Temples: natural or receding?.

True recession

• The line is clearly higher than a few years ago, when comparing photographs taken in the same way.
• The hairs at the margin look different: thinner, broken, isolated or with redness around them.
• There are other signs: thinner eyebrows, paler forehead skin near the line, temple recession, a thin crown.

To measure the front hairline objectively, see How to measure your hairline at home.

Causes of front hairline recession

In women, a receding front hairline is less common and so deserves special attention: the most likely causes are traction and frontal fibrosing alopecia.

Frontal fibrosing alopecia: what to know

What it is

A scarring alopecia, considered a variant of lichen planopilaris. Inflammation around the follicles of the front hairline gradually destroys them and replaces them with fibrous tissue. Lost hair does not grow back.

It was described by Kossard (1994), in women after the menopause. Since then, the number of cases has risen remarkably, and some authors speak of an "emerging epidemic". It mainly affects women after the menopause, but also women of childbearing age and men (Starace et al., 2024).

Characteristic signs

• Recession of the front hairline in a regular band, which may extend to the temples and above the ears. The average rate described is about 0.9 mm per month.
• Pale, smooth, shiny skin in the area where there was hair, contrasting with the more tanned skin of the forehead.
• Loss of eyebrows, in 50% to 75% of cases, often before recession of the hair is noticed.
• "Lonely hairs": isolated hairs that are left behind, in front of the new line.
• Redness and scaling around the hairs at the margin.
• Small skin-coloured bumps on the face, especially on the temples and cheeks (facial papules).
• Sometimes: loss of eyelashes, of arm and leg hair and of hair at the nape; in men, of the beard.
• Symptoms: itching or burning, but many people feel nothing.

And sunscreens?

Several case-control studies have found an association between frontal fibrosing alopecia and the daily use of sunscreens and leave-on facial creams (Aldoori et al., 2016). In one of them, 88% of patients used sunscreen daily all year round, compared with 29% of controls. Association is not causation: it has not been shown that sunscreens cause the condition, and the mechanism remains unknown. Sun protection prevents skin cancer and should not be given up for this reason. If you have frontal fibrosing alopecia, talk to your doctor about which products to use on your forehead and hairline.

Signs that should not wait

These signs suggest a scarring alopecia. Time counts: every millimetre lost is permanent, and early treatment increases the chance of stabilising.

Diagnosis and treatment

How the diagnosis is made

• Clinical history: when it started, eyebrows, symptoms, hairstyles, menopause, products used on the forehead, family history.
• Examination of the front hairline, temples, eyebrows, face and nape.
• Trichoscopy: in frontal fibrosing alopecia it shows absence of follicular openings, redness and scaling around the hairs and absence of fine hairs at the margin (the "lonely hair"). In baldness, hairs of varying thickness; in traction, broken hairs and the fringe sign.
• Standardised measurements and photographs of the front hairline, to know whether it is advancing or stable.
• Biopsy, in doubtful cases, to confirm scarring alopecia.

What is possible in frontal fibrosing alopecia

There is no standard treatment or cure. The aim is to stop the inflammation and stabilise the line. The options, chosen case by case, include:

• Topical or injected corticosteroids at the active margin and on the eyebrows.
• Topical calcineurin inhibitors.
• Oral medicines such as 5-alpha-reductase inhibitors, hydroxychloroquine, tetracyclines or isotretinoin (the latter also improves facial spots). Most are used outside their approved indications and require medical supervision.
• Minoxidil, as a complement.
• Camouflage: eyebrow micropigmentation, hairstyles with a fringe.

In some cases, the condition stabilises spontaneously. Hair transplant is only considered if the condition has been inactive for a long time, and results are variable.

For other causes

• Baldness: minoxidil, finasteride (with the precautions described on the page on male pattern baldness) and, in selected cases, transplant.
• Traction: relieve the tension; treat the inflammation. See Tight hairstyles and the hairline.
• Alopecia areata: specific treatments. See Alopecia areata: what it is and how to recognise it.

When to assess

Without delay (weeks)

If you have any of the signs in the previous section: thinning eyebrows, band-like recession with pale skin, isolated hairs, redness or scaling at the margin, skin-coloured bumps on the face.

Scheduled consultation

• Your forehead looks higher and you want to know whether it is recession or natural shape.
• The temples and crown are receding.
• You wear pulled-back hairstyles and the front hairline has thinned.

At Luxmed, the Hair Medicine consultation includes examination of the front hairline, eyebrows and face, trichoscopy, measurements and standardised photographs to track progress. When a scarring alopecia is suspected, we arrange the necessary tests and treatment, or the appropriate referral.

This article is for information purposes and does not replace a medical consultation. The results of any treatment vary from person to person.

Frequently asked questions