Evaluating the combined efficacy of oral isotretinoin and topical tacrolimus versus oral finasteride and topical tacrolimus in frontal fibrosing alopecia—A randomized controlled trial

Abstract

Objective: Treatment of frontal fibrosing alopecia (FFA) is complicated and challenging. In this study, we evaluated the efficacy of combining topical tacrolimus with isotretinoin versus finasteride in patients with FFA.Methodology: Thirty-one patients with FFA were divided randomly into two groups.Therapeutic regimen of the first group (group A, n = 16) was isotretinoin and tacrolimus (Capsule isotretinoin 20 mg daily and topical tacrolimus 0.1% BD). The second group (group B, n = 15) was given finasteride and tacrolimus (Tablet finasteride 2.5 mg daily and topical tacrolimus 0.1% BD). Patients were treated and followed up periodically for 12 weeks. Evaluation of the treatment efficacy was based on Patient Global Assessment and Physician Global Assessment scales. Objective evaluation was based on improving the severity of skin lesions by viewing serial images taken from the affected areas.Results: Physician Global Assessment (PGA) was significantly better in the group A as compared with the group B at 4 weeks (p = 0.038). Physician satisfaction in the group A was better than the group B at 12 weeks, but this was not statistically significant (p > 0.05). Patient Global Assessment and patient satisfaction in the group A was better than the group B at 8 and 12 weeks, but it was not statistically significant (p > 0.05). Conclusion:Although both therapeutic regimens were effective in the treatment of FFA, treatment with tacrolimus and isotretinoin is significantly more effective than tacrolimus and finasteride.

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

“…A recent RCT conducted by Rokni et al showed treatment with tacrolimus and isotretinoin is superior to tacrolimus and finasteride 22 . Another study demonstrated that a combination of isotretinoin with topical treatments is more effective than only topical application of clobetasol and tacrolimus 23 …”

“…Two recent studies have shown that isotretinoin in addition to 5αRIs and hydroxychloroquine is effective in reducing inflammation of the frontotemporal hairline and treating facial papules 4,22,23,24 …”

“…14,21 A recent RCT conducted by Rokni et al showed treatment with tacrolimus and isotretinoin is superior to tacrolimus and finasteride. 22 Another study demonstrated that a combination of isotretinoin with topical treatments is more effective than only topical application of clobetasol and tacrolimus. 23 Two recent studies have shown that isotretinoin in addition to 5αRIs and hydroxychloroquine is effective in reducing inflammation of the frontotemporal hairline and treating facial papules.…”

“…As a summary of data from retrospective studies and two recent RCTs, it seems like for other alopecia including AGA, 28,29 most favorable outcomes may be obtained through combination therapy using the conjunction of 5αRI, hydroxychloroquine, isotretinoin, and topical calcineurin inhibitors. 11,19,21,22 However, further studies with larger sample sizes and narrower age ranges (pre-or post-menopausal) and longer follow up are needed to determine the optimal treatment approach for FFA.…”

“…23 Two recent studies have shown that isotretinoin in addition to 5αRIs and hydroxychloroquine is effective in reducing inflammation of the frontotemporal hairline and treating facial papules. 4,22,23,24 However, caution should be exercised when using 5αRIs or isotretinoin as first-line treatment for women of childbearing potential due to their teratogenicity. 10,13 Furthermore, it is important to Improvement in hairline and facial papules after 6 months of treatment with finasteride and topical isotretinoin (F).…”