Therapeutic options in frontal fibrosing alopecia

ABSTRACT

Introduction: The prevalence of frontal fibrosing alopecia (FFA) is increasing worldwide and early diagnosis and prompt treatment are necessary to prevent definitive scarring. Currently, there are no FDA approved treatments for FFA. This paper seeks to explore the efficacy of current therapeutic options in FFA.

Areas covered: The evidence available to date gives some guidance as to potential effective treatment approaches for FFA patients which include 5-alpha-reductase inhibitors, intralesional steroids, hydroxychloroquine, topical calcineurin inhibitors, excimer laser, pioglitazone, oral tetracyclines and minoxidil. A MEDLINE search (PubMed 1994–2015) was performed to identify the cases described in the literature. The MEDLINE search terms Frontal Fibrosing Alopecia and Treatment were used in combination with no language restrictions. We included case reports, case series, review articles and clinical trials which specifically mentioned attempted therapeutic modalities in FFA and their respective outcomes following treatment.

Expert opinion: I first reported the efficacy of finasteride in FFA patients 12 years ago and still widely utilize this medication when treating patients with FFA. In treating FFA patients I prefer to associate oral finasteride to topical tacrolimus, hydroxychloroquine and excimer laser in patients with clinical or dermoscopic evidence of active inflammation.

KEYWORDS:

• FFA
• FFA therapy
• frontal fibrosing alopecia
• treatment

Article highlights

• The prevalence of FFA is increasing worldwide and the disease is increasingly seen in young women and men

• The main objective of treatment is to reduce inflammation and prevent disease progression

• Disease activity is better evaluated with dermoscopy with peripilar casts being a good indicator of progression

• Data on treatment options derive from retrospective studies and not from randomized clinical trials

• Evidence of stabilization was seen in most patients treated with 5-alpha-reductase inhibitors

This box summarizes key points contained in the article.

Declaration of interest

A Tosti has received honoraria as a speaker, advisory board member or consultant from Merck Sharpe Dohme, Incyte, Phytera, Aclaris, DS Laboratories and Procter & Gamble. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.