ReviewMedical therapy for frontal fibrosing alopecia: A review and clinical approach
Section snippets
Methods
All the literature on medical therapies for FFA was retrieved through PubMed. An electronic search of “frontal fibrosing alopecia” on July 19, 2018, resulted in 270 items. Only publications in English on the clinical outcomes of treatment modalities for FFA were considered. A total of 23 studies were identified, and we summarized the details of these studies in Table I.∗ Each study was assigned a level of evidence
Results
The FFA treatment courses of 622 individuals (excluding those without treatments and those with hair transplants) were reviewed. The most common primary agent was intralesional corticosteroids, specifically intralesional triamcinolone acetonide (TAC), which represented 35% (215/622) of therapies, followed by 5α-RIs, which represented 29% (182/622) of therapies. Few studies reported the use of PPAR-γ agonists (1%, 5/622) and immunosuppressants (3%, 17/622).
Discussion
Evaluating the response of individual therapeutic agents is difficult. Monotherapy is seldom used, and most patients reported in the literature are treated with a combination of therapies. The responses of patients on multiple treatment modalities could be attributed to other therapies or the combination of therapies. The natural disease course of FFA is also obscure, and hair loss might be self-limiting if left untreated.1, 2 In a retrospective cohort study, Rallis et al reported that in 6
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2022, Anais Brasileiros de DermatologiaCitation Excerpt :The main targeted therapies against the lymphocytic inflammation of FFA are hydroxychloroquine and doxycycline. These drugs have anti-inflammatory properties and an acceptable adverse effect profile.35 Chiang et al. evaluated the efficacy of hydroxychloroquine 400 mg/day on LPP and FFA using the LPPAI activity index.
Scalp and serum profiling of frontal fibrosing alopecia reveals scalp immune and fibrosis dysregulation with no systemic involvement
2022, Journal of the American Academy of DermatologyCitation Excerpt :The use of 5-α-reductase-inhibitors, which are used to treat androgenic alopecia,20-23 slow the progression of FFA,15,24,25 but patients only achieve modest hair regrowth and there are safety concerns, including sexual dysfunction and psychiatric changes.15,18,24 Observational studies and case series have suggested that immune-modulating agents (eg, hydroxychloroquine, PPAR-γ agonists, and JAK inhibitors) hold the potential to stabilize the disease and induce hair regrowth.15,18,25-28 Past studies of FFA and lichenplanopilaris (LPP), another scarring hair loss disorder phenotypically associated with FFA, showed lymphocytic and CD8+ T-cell infiltration of the perifollicular bulge and fibrotic remodeling of the hair follicle.29-35
Hydroxychloroquine: An Essential Drug in Dermatology and Its Controversial Use in COVID-19
2022, Actas Dermo-SifiliograficasFrontal fibrosing alopecia. The importance of early diagnosis
2021, FMC Formacion Medica Continuada en Atencion Primaria
Funding sources: None.
Conflicts of interest: Dr Shapiro is a consultant for Aclaris Therapeutics, Incyte, and RepliCel Life Sciences and is a principal investigator for RegenLab. Anthony Ho has no conflicts of interest to disclose.