Therapeutic response of facial papules and inflammation in frontal fibrosing alopecia to low-dose oral isotretinoin

Pham, Christine; Hosking, Anna-Marie; Cox, Surget V.; Mesinkovska, Natasha Atanaskova

doi:10.1016/j.jdcr.2020.01.030

Cited by 13 publications

(24 citation statements)

References 13 publications

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“…These recent observations raise the concept of isotretinoin as a potential therapeutic option for facial papules in FFA, by inducing sebaceous gland atrophy 7,8 . Our case endorses a well‐tolerated regimen of 20 mg once daily for up to 6 months, with no recurrence after 2 years.…”

Section: Discussionsupporting

confidence: 66%

“…A 48-year-old Caucasian female presented with a seven-year history of bilateral eyebrow loss, and a two-year history of multiple monomorphic, asymptomatic, skin-colored papular lesions localized to the chin, cheeks, and nose ( Figure 1A These recent observations raise the concept of isotretinoin as a potential therapeutic option for facial papules in FFA, by inducing sebaceous gland atrophy. 7,8 Our case endorses a well-tolerated regimen of 20 mg once daily for up to 6 months, with no recurrence after 2 years. More research is need to clarify optimal treatment regimen and to further define the mechanism of action of isotretinoin in this context, particularly given recent movement of the evidence-base away from vellus hair follicle involvement, towards an understanding that prominent sebaceous glands may represent the primary explanation for the formation of facial papules in the setting of FFA.…”

Section: Case Reportmentioning

confidence: 51%

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Facial papules of frontal fibrosing alopecia—Response to oral isotretinoin

Campbell

McKenna²

2020

Dermatologic Therapy

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BACKGROUND Frontal fibrosing alopecia (FFA) is a primary lymphocytic cicatricial alopecia in which hair follicles are destroyed and permanently replaced by scar-like tissue, resulting in recession of the frontotemporal/occipital hairline, and a decrease or complete loss of the eyebrows. Histology classically shows a perifollicular lichenoid infiltrate, with varying degrees of lamellar fibrosis. Involved skin is smooth and atrophic, lacking follicular ostia. Other clinical features include depression of the frontal veins, "lonely hairs," hairline hypopigmentation, thinning of body hair, facial dots/erythema, and facial papules. Together these features suggest that FFA does not affect the scalp in isolation, but can also affect skin at other sites. 1

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Section: Discussionsupporting

confidence: 66%

Section: Case Reportmentioning

confidence: 51%

Facial papules of frontal fibrosing alopecia—Response to oral isotretinoin

Campbell

McKenna²

2020

Dermatologic Therapy

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“…All of these patients achieved symptomatic improvement including improvement in their facial papules. 59 Additionally, two of the three patients experienced eyebrow hair regrowth. 59 In a case report, Pirmez and colleagues reported the results of utilizing isotretinoin in three patients with FFA who also had the characteristic facial papules.…”

Section: Other Systemic Therapiesmentioning

confidence: 96%

“… 59 Additionally, two of the three patients experienced eyebrow hair regrowth. 59 In a case report, Pirmez and colleagues reported the results of utilizing isotretinoin in three patients with FFA who also had the characteristic facial papules. 60 Patients were reported to have received isotretinoin for 3 months, at 20 mg per day, titrated up to 40 mg per day.…”

Section: Other Systemic Therapiesmentioning

confidence: 96%

“…Systemic retinoids have also previously been used to treat LPP and it is thought that they may play a role in hair follicular keratinocyte antigen expression, reducing inflammatory infiltrates and suppressing T-cell-mediated destruction. 33 , 59 Based on this, treatment with systemic retinoids has been proposed in patients with FFA. In a retrospective cohort study conducted by Rakowska and colleagues, 40 patients with FFA were treated with systemic retinoids; with 29 patients receiving 20 mg of isotretinoin daily and 11 patients receiving 20 mg of acitretin daily, while a control group of 14 patients received finasteride 5 mg daily.…”

Section: Other Systemic Therapiesmentioning

confidence: 99%

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<p>Optimal Management of Frontal Fibrosing Alopecia: A Practical Guide</p>

Imhof

Tolkachjov²

2020

CCID

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Frontal fibrosing alopecia (FFA) is a primary lymphocytic cicatricial alopecia that is often considered a clinical variant of lichen planopilaris (LPP) due to their shared histopathologic features. FFA is characterized by the recession of the frontal, temporal, or frontotemporal hairline; the clinical pattern is distinct and usually includes eyebrow hair loss, as well as other associated symptoms. Pruritus, facial papules, eyelash loss, body hair involvement, and trichodynia may also occur in addition to the frontotemporal recession and eyebrow loss classically seen. Early diagnosis and prompt treatment are critical as FFA is a progressive disorder that can result in permanent hair loss. FFA is challenging as patients may not present or be recognized until the disease has progressed. Additionally, there is currently no consensus or standard treatment regimen for FFA. While many different therapies have been reported as beneficial, there are a limited number of published guidelines for the treatment of FFA. This article is a review of the literature on treatment modalities for FFA and the objective is to offer a practical guide for clinicians on the evidence-based management options currently available in the literature.

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