Frontal fibrosing alopecia: efficacy of treatment modalities

Figures & data

Table 1 Summary table of FFA treatment studies included in this review. 

Treatment	Study	No. of patients	Results	Comments	ACP grade
5-α-reductase-inhibitors (finasteride)	Vañó-Galván et al^Citation2 (2014)	102	Improvement: 48 (47%) Stabilization: 54 (53%)	Dosage: 2.5–5.0 mg/day	Moderate
	Ladizinski et al^Citation4 (2013)	3	Stabilization: 1 (33%)	Dosage: 1.0–2.5 mg/day^a	Low
	Moreno-Ramirez et al^Citation8 (2005)	7	Stabilization: 7 (100%)	Dosage: 2.5 mg/day in combination therapy^b	Very low
	Tosti et al^Citation72 (2005)	8	Stabilization: 4 (50%)	Dosage: 2.5 mg/day	Very low
	Rallis et al^Citation23 (2010)	5	Stabilization: 3 (60%) Worsening: 2 (40%)	Dosage: 2.5 mg/day + minoxidil solution 5% for 12 months	Very low
5-α-reductase-inhibitors (dutasteride)	Vañó-Galván et al^Citation2 (2014)	18	Improvement: 8 (44%) Stabilization: 10 (56%)	Dosage: 0.5 mg/week	Moderate
	Ladizinski et al^Citation4 (2013)	10	Stabilization: 7 (70%)	Dosage: 0.5 mg/day and 0.5 mg/week^c	Low
	Georgala et al^Citation44(2009)	13	Improvement: 2 (15%) Stabilization: 6 (62%)	Dosage: 0.5 mg/day	Low
Intralesional steroids	Banka et al^Citation10 (2014)	57	Stabilization + reduction in symptoms: 55 (97%)	+ Topical clobetasol propionate 0.05%	Low
	Moreno-Ramirez et al^8(2005)	15	Stabilization: 14 (93%)	Dosage: 20 mg/mL every 3 months	Very low
	Vañó-Galván et al^Citation2 (2014)	130	Improvement: 44 (34%) Stabilization: 64 (49%) Worsening: 6 (5%)	Mean of 8 injections per patient One injection every 3–6 months	Moderate
	Donovan et al^Citation30 (2015)	11	Complete response with hair regrowth in 10 patients at 3 and 6 month follow-up.	10 mg/mL	Very low
Hydroxychloroquine	Strazzulla et al^Citation39 (2018)	32	Results specific to hydroxychloroquine not reported	Administered as part of a systemic therapy	Low
	Vañó-Galván et al^Citation2 (2014)	54	Improvement: 8 (15%) Stabilization: 32 (59%) Worsening: 12 (22%)	Dosage: 200–400 mg/day	Moderate
	Ladizinski et al^Citation4 (2013)	4	Stabilization: 2 (50%)	Dosage: 400 mg/day	Low
Topical corticosteroids	Heppt et al^Citation40 (2018)	48	Improvement: 19 (40%) Stabilization: 12 (25%) Worsening: 11 (23%)	Treated with alternation of topical steroids and pimecrolimus 1% cream Followed for an average of 20 months	Low
	Moreno-Arrones et al^Citation28 (2017)	106	Stabilization: 40 (38%)	Topical clobetasol (0.5% foam, twice/week) with oral dutasteride (0.5 mg, thrice/week)	Moderate
	Rallis et al^Citation23 (2010)	6	Improvement: 0 (0%)	Topical clobetasol 0.05% monotherapy daily	Very low
Topical calcineurin inhibitors	MacDonald et al^Citation11 (2012)	22	Uncertain		Low
Systemic retinoids	Rakowska et al^Citation33 (2017)	40	Stabilization: 30 (75%) No further progression after discontinuation of treatment: 29 (73%)	Dosage: 20 mg isotretinoin or acitretin/day	Moderate
Pioglitazone	Baibergenova and Walsh^Citation63 (2012)	24 with LPP	Remission: 5 Improvement: 12 No change: 3	Dosage: 15 mg/day	Very low
	Mesinkovaska et al^Citation59 (2015)	22 with LPP	Marked improvement: 16 (72%) New hair growth: 6 (27%)	Dosage: 15 mg/day	Very low
	Ladizinski et al^Citation4 (2013)	1	Lack of response	Dosage: 15 mg/day	Low
	Mirmirani and Karnik^Citation62 (2009)	1 with LPP	Complete response	Dosage: 15 mg/day	Very low
Oral tetracyclines	Ladizinski et al^Citation4 (2013)	3	Stabilization: 2	Doxycycline + Dutasteride	Low
	Samrao et al^Citation12 (2010)	4	At 6-month follow-up: response: 1 Partial response: 1 No response: 2	Doxycycline	Low
	Banka et al^Citation10 (2014)	13	Stabilization: 13 (100%)	Doxycycline 100 mg twice daily or tetracycline 500 mg twice daily	Low
Topical minoxidil	Cranwell et al^Citation31 (2017)	1	Stabilization: 1	+ Dutasteride	Very low
	Tan and Messenger^Citation9 (2009)	2	Stabilization: 2	+ Intralesional steroids	Very low
	Tosti et al^72 (2005)	8	Arrest of disease progression: 4 (50%)	+ Finasteride 2.5 mg/day	Very low
Excimer laser	Navarini et al^Citation74 (2011)	13 with LPP	Significant reduction in clinical signs of inflammation	Frequency: twice/week Cumulative mean dosage: 4300 mj/cm	Very low
	Vavricka et al^Citation75 (2006)	13 with LPP	Positive response in all 3 patients—2 with hair growth and 1 with decreased pruritis	Average of 10 excimer laser treatments	Very low
Hair transplantation	Liu et al^Citation45 (2018)	2	Graft survival during 3–4 year follow-up period		Very low
	Gurfinkiel et al^Citation46 (2011)	1	Hair growth sustained after 6 years	+ Oral finasteride, topical minoxidil, betamethasone	Very low
	Jiménez and Poblet^77 (2013)	3	Transplanted hair lost after 3 years		Very low
	Nusbaum and Nusbaum^Citation6 (2010)	1	Transplanted hair lost after 4 years		Very low

Notes: ^aIf premenopausal, women were treated in combination with oral contraceptive therapy. ^bGiven in combination with topical minoxidil 5% twice daily and intralesional triamcinolone acetonide injections (20 mg/mL three times monthly). ^c0.5 mg daily for 2 weeks followed by 0.5 mg weekly thereafter for postmenopausal women.

Vañó-Galván S, Molina-Ruiz AM, Serrano-Falcón C, et al. Frontal fibrosing alopecia: A multicenter review of 355 patients. J Am Acad Dermatol. 2014;70(4):670–678. doi:10.1016/j.jaad.2013.12.00324508293

 PubMed Web of Science ®Google Scholar

Ladizinski B, Bazakas A, Selim MA, Olsen EA. Frontal fibrosing alopecia: A retrospective review of 19 patients seen at Duke University. J Am Acad Dermatol. 2013;68(5):749–755. doi:10.1016/j.jaad.2012.09.04323375454

 PubMed Web of Science ®Google Scholar

Moreno-Ramírez D, Martínez FC. Frontal fibrosing alopecia: A survey in 16 patients. J Eur Acad Dermatol Venereol. 2005;19(6):700–705. doi:10.1111/j.1468-3083.2005.01291.x16268874

 PubMed Web of Science ®Google Scholar

Tosti A, Piraccini BM, Iorizzo M, Misciali C. Frontal fibrosing alopecia in postmenopausal women. J Am Acad Dermatol. 2005;52(1):55–60. doi:10.1016/j.jaad.2004.05.01415627081

 PubMed Web of Science ®Google Scholar

Rallis E, Gregoriou S, Christofidou E, Rigopoulos D. Frontal fibrosing alopecia: to treat or not to treat? J Cutan Med Surg. 2010;14(4):161–166. doi:10.2310/7750.2010.0904120642984

 PubMed Web of Science ®Google Scholar

Fertig R, Aleid NM, Antonella T. Therapeutic options in frontal fibrosing alopecia. Expert Opin Orphan Drugs. 2016;4(5):461–468. doi:10.1517/21678707.2016.1173539

 Web of Science ®Google Scholar

Banka N, Mubki T, Bunagan MJK, McElwee K, Shapiro J. Frontal fibrosing alopecia: a retrospective clinical review of 62 patients with treatment outcome and long-term follow-up. Int J Dermatol. 2014;53(11):1324–1330. doi:10.1111/ijd.1247924738979

 PubMed Web of Science ®Google Scholar

Donovan JC. Finasteride-mediated hair regrowth and reversal of atrophy in a patient with frontal fibrosing alopecia. JAAD Case Rep. 2015;1(6):353. doi:10.1016/J.JDCR.2015.08.00327051778

 PubMedGoogle Scholar

Strazzulla LC, Avila L, Li X, Lo Sicco K, Shapiro J. Prognosis, treatment, and disease outcomes in frontal fibrosing alopecia: A retrospective review of 92 cases. J Am Acad Dermatol. 2018;78(1):203–205. doi:10.1016/j.jaad.2017.07.03529241787

 PubMed Web of Science ®Google Scholar

Heppt MV, Letulé V, Laniauskaite I, et al. Frontal fibrosing alopecia: a retrospective analysis of 72 patients from a German academic center. Facial Plast Surg. 2018;34(1):88–94. doi:10.1055/s-0037-161528129278862

 PubMed Web of Science ®Google Scholar

Moreno-Arrones OM, Saceda-Corralo D, Fonda-Pascual P, et al. Frontal fibrosing alopecia: clinical and prognostic classification. J Eur Acad Dermatol Venereol. 2017;31(10):1739–1745. doi:10.1111/jdv.1428728426907

 PubMed Web of Science ®Google Scholar

MacDonald A, Clark C, Holmes S. Frontal fibrosing alopecia: a review of 60 cases. J Am Acad Dermatol. 2012;67(5):955–961. doi:10.1016/j.jaad.2011.12.03822503342

 PubMed Web of Science ®Google Scholar

Rakowska A, Gradzinska A, Olszewska M, Rudnicka L. Efficacy of isotretinoin and acitretin in treatment of frontal fibrosing alopecia: retrospective analysis of 54 cases. J Drugs Dermatol. 2017;16(10):988–992.29036252

 PubMed Web of Science ®Google Scholar

Baibergenova A, Walsh S. Use of pioglitazone in patients with lichen planopilaris. J Cutan Med Surg. 2012;16(2):97–100. doi:10.2310/7750.2011.1100822513061

 PubMed Web of Science ®Google Scholar

Mesinkovska NA, Tellez A, Dawes D, Piliang M, Bergfeld W. The use of oral pioglitazone in the treatment of lichen planopilaris. J Am Acad Dermatol. 2015;72(2):355–356. doi:10.1016/j.jaad.2014.10.03625592345

 PubMed Web of Science ®Google Scholar

Mirmirani P, Karnik P. Lichen planopilaris treated with a peroxisome proliferator-activated receptor gamma agonist. Arch Dermatol. 2009;145(12):1363–1366. doi:10.1001/archdermatol.2009.28320026843

 PubMed Web of Science ®Google Scholar

Samrao A, Chew A-L, Price V. Frontal fibrosing alopecia: a clinical review of 36 patients. Br J Dermatol. 2010;163(6):1296–1300. doi:10.1111/j.1365-2133.2010.09965.x20698851

 PubMed Web of Science ®Google Scholar

Cranwell WC, Sinclair R. Familial frontal fibrosing alopecia treated with dutasteride, minoxidil and artificial hair transplantation. Australas J Dermatol. 2017;58(3):e94–e96. doi:10.1111/ajd.1249927273740

 PubMed Web of Science ®Google Scholar

Tan KT, Messenger AG. Frontal fibrosing alopecia: clinical presentations and prognosis. Br J Dermatol. 2009;160(1):75–79. doi:10.1111/j.1365-2133.2008.08861.x18811690

 PubMed Web of Science ®Google Scholar

Navarini A, Kolios A, Prinz-Vavricka B. Low-dose excimer 308-nm laser for treatment of lichen planopilaris. Arch Dermatol. 2011;147(11):1325–1326. doi:10.1001/archdermatol.2011.33522106124

 PubMed Web of Science ®Google Scholar

Vavricka BP, Haug S, Eliades I, Trueb R. 308-nm excimer laser treatment of lichen planopilaris of the scalp. Dermatology. 2006;213:74.

 Google Scholar

Liu Y-CS, Jee S-H, Chan J-YL. Hair transplantation for the treatment of lichen planopilaris and frontal fibrosing alopecia: A report of two cases. Australas J Dermatol. 2018;59(2):e118–e122. doi:10.1111/ajd.1268228736812

 PubMed Web of Science ®Google Scholar

Gurfinkiel A, Garcia-Igarza H. Hair transplantation in a patient with frontal fibrosing alopecia associated with lichen scleroatrophicus vulvae. Dermatologia Argentina. 2011;17:110–115.

 Google Scholar

Nusbaum BP, Nusbaum AG. Frontal fibrosing alopecia in a man: results of follicular unit test grafting. Dermatol Surg. 2010;36(6):959–962. doi:10.1111/j.1524-4725.2010.01580.x20482728

 PubMed Web of Science ®Google Scholar