Medical Therapy for Frontal Fibrosing Alopecia: A Review and Clinical Approach

The 2019 document reviews the effectiveness of medical therapies for frontal fibrosing alopecia (FFA), a condition that leads to permanent hair loss. The authors analyzed 270 items, including case reports and retrospective cohort studies, and found that intralesional steroids and 5α-reductase inhibitors had the highest reported effectiveness at 88%. Other treatments like oral prednisone, topical steroids, antibiotics, pioglitazone, systemic retinoids, and hair transplantation were also evaluated. The review suggests that early intervention may alter the disease course, but highlights the permanent nature of hair loss in FFA. It also points out the lack of placebo-controlled studies and uniform outcome measures. The document discusses a range of treatments from topical agents to hair transplants, noting variable responses and the potential influence of environmental factors. The authors propose a clinical approach based on their review and experience, reporting eyebrow regrowth in 71% of patients and varied responses to treatments over 6 to 12 months. The conclusion emphasizes the need for more rigorous studies to determine the efficacy of treatments for FFA.