Clinical effectiveness of finasteride versus hydroxychloroquine in the treatment of frontal fibrosing alopecia: A randomized controlled trial

Abstract

BackgroundFrontal fibrosing alopecia (FFA) is a cicatricial alopecia with rapid epidemic growth. However, there is no agreement on the best therapeutic approach.AimsTo compare the therapeutic effects of finasteride as a first‐line systemic treatment of FFA versus hydroxychloroquine as a relatively safe and effective immunosuppressive drug.MethodsThirty‐four female FFA patients were randomly assigned to receive either 400 mg/day of hydroxychloroquine or 2.5 mg/day of finasteride for 6 months. Topical treatments in both groups include pimecrolimus, mometasone, and minoxidil. Treatment efficacy was evaluated using the Frontal Fibrosing Alopecia Severity Score (FFASS), photography, and trichoscopy after 3 and 6 months.ResultsBoth the finasteride and hydroxychloroquine groups showed significant improvements in FFASS and trichoscopic scores (p < 0.01). However, there was no significant difference between the two groups during the study. Photographic assessment showed that more than 60% of patients in both groups had improved without statistically significant differences between the two groups.ConclusionsBoth finasteride and hydroxychloroquine are equally effective, safe, and well‐tolerable for treating FFA patients.

The Frontal Fibrosing Alopecia Treatment Dilemma

“…A positive response is observed after 6-12 months [45,83,84]. Moreover, hydroxychloroquine and 5-ARIs appear to demonstrate comparable efficacy, as confirmed by a randomized study involving 36 patients [85].…”

“…Data from the literature suggest that ILTA, 5-ARIs, retinoids, and hydroxychloroquine are the most effective therapeutic options. First-line medications should be chosen individually, based on the drug safety profile, the FFA phenotype, and the presence of coexisting conditions [19,85].…”