Therapeutic options in frontal fibrosing alopecia

Fertig, Raymond; Aleid, Nouf Mohammed; Tosti, Antonella

doi:10.1517/21678707.2016.1173539

Cited by 2 publications

(3 citation statements)

References 58 publications

(128 reference statements)

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“…For this reason, patients receiving this drug should be under ophthalmologic control. Other side-effects include gastrointestinal upset, headache, myopathy; however, hydroxychloroquine is safe in pregnancy [5,63]. It should be noted that the onset of action of the drug is slow, and a satisfactory response is usually obtained after 6-12 months of treatment [5,64].…”

Section: α-Reductase Inhibitors (5α-ris)mentioning

confidence: 99%

Frontal Fibrosing Alopecia – a review and a practical guide for clinicians

Kępińska¹,

Jałowska²,

Bowszyc‐Dmochowska³

2021

Ann Agric Environ Med.

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Despite a significant increase in reported cases of frontal fibrosing alopecia (FFA) in literature, discussion about the possible role of environmental factors, instruction for diagnosis and guideline for treatment, are limited. The review aims to provide a detailed synthesis of this condition that could be used by clinicians in their practise. Whether single-centre or multicentre, studies of more than 60 cases less than 5 years old were mainly taken into consideration. Results obtained were that FFA affects mainly postmenopausal Caucasian women; the most common comorbidities are hyperlipidaemia, arterial hypertension, osteoporosis, hypothyroidism, depression, alongside dermatological disorders such as atopic dermatitis, rosacea, seborrheic dermatitis and androgenetic alopecia. Autoimmune, genetic, hormonal (e.g. estrogen deficiency, pregnancy, lactation, HRT and raloxifene) and environmental (e.g. daily use of facial sunscreens and less frequent use of hair dyes and shampoo) hypotheses were proposed for pathogenesis, as well as association with various predisposing factors (patient's health-social profile, disease's history and comorbidities). Clinical presentation of FFA can be divided into 3 specific patterns, each with a different prognosis. Diagnosis is usually made clinically with the use of trichoscopy; however, scalp biopsy remains the gold standard. The condition is regarded as a variant of lichen planopilaris (LPP) due to the similarity of the prominent histopathological findings, but the clinical image is distinct and therapeutic options vary. 5α-reductase inhibitors, intralesional steroids, and hydroxychloroquine provide the highest level of evidence for the treatment of FFA. The conclusion is that a better understanding of the disease is crucial for proper disease management.

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Section: α-Reductase Inhibitors (5α-ris)mentioning

confidence: 99%

Frontal Fibrosing Alopecia – a review and a practical guide for clinicians

Kępińska¹,

Jałowska²,

Bowszyc‐Dmochowska³

2021

Ann Agric Environ Med.

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“…TreatmentStudyNo. of patientsResultsCommentsACP grade5-α-reductase-inhibitors(finasteride)Vañó-Galván et al2 (2014)102Improvement: 48 (47%)Stabilization: 54 (53%)Dosage: 2.5–5.0 mg/dayModerateLadizinski et al4 (2013)3Stabilization: 1 (33%)Dosage: 1.0–2.5 mg/day a LowMoreno-Ramirez et al8 (2005)7Stabilization: 7 (100%)Dosage: 2.5 mg/day in combination therapy b Very lowTosti et al72 (2005)8Stabilization: 4 (50%)Dosage: 2.5 mg/dayVery lowRallis et al23 (2010)5Stabilization: 3 (60%)Worsening: 2 (40%)Dosage: 2.5 mg/day + minoxidil solution 5% for 12 monthsVery low5-α-reductase-inhibitors(dutasteride)Vañó-Galván et al2 (2014)18Improvement: 8 (44%)Stabilization: 10 (56%)Dosage: 0.5 mg/weekModerateLadizinski et al4 (2013)10Stabilization: 7 (70%)Dosage: 0.5 mg/day and 0.5 mg/week c LowGeorgala et al44(2009)13Improvement: 2 (15%)Stabilization: 6 (62%)Dosage: 0.5 mg/dayLowIntralesional steroidsBanka et al10 (2014)57Stabilization + reduction in symptoms: 55 (97%)+ Topical clobetasol propionate 0.05%LowMoreno-Ramirez et al 8 (2005)…”

Section: Methodsmentioning

confidence: 99%

“…Of note, prescribers should keep in mind hydroxychloroquine has a slow onset of action and peak effectiveness is not achieved until 6–12 months 43. Side effects include gastrointestinal upset, headache, myopathy, and rarely retinal toxicity, but hydroxychloroquine is safe in pregnancy 44…”

Section: Hydroxychloroquinementioning

confidence: 99%

<p>Frontal fibrosing alopecia: efficacy of treatment modalities</p>

Gamret¹,

Potluri²,

Krishnamurthy³

et al. 2019

IJWH

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Frontal fibrosing alopecia (FFA) is a primary cicatricial alopecia characterized by loss of follicular stem cells, fibrosis, and a receding frontotemporal hairline, with frequent loss of eyebrows, and less commonly, body hair involvement. Diagnosis is clinical and the disease most often affects postmenopausal women. Treatment is difficult with the goal of disease stabilization rather than hair regrowth due to the scarring nature of FFA. To date, there are no randomized controlled trials evaluating efficacy of treatments. Therefore, much of our knowledge is based on small retrospective studies. In this review, we highlight the various and most current treatment options for FFA, including 5-α-reductase inhibitors, intralesional steroids, hydroxychloroquine, topical steroids, topical calcineurin inhibitors, systemic retinoids, pioglitazone, oral antibiotics, minoxidil, excimer laser, and hair transplantation. Currently, 5-α-reductase inhibitors, intralesional steroids, and hydroxychloroquine have the highest level of evidence for treating FFA, while the remaining therapies have variable results and require further data to draw definitive conclusions.

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Therapeutic options in frontal fibrosing alopecia

Cited by 2 publications

References 58 publications

Frontal Fibrosing Alopecia – a review and a practical guide for clinicians

Frontal Fibrosing Alopecia – a review and a practical guide for clinicians

<p>Frontal fibrosing alopecia: efficacy of treatment modalities</p>

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