Medical therapy for frontal fibrosing alopecia: A review and clinical approach

Background Guidelines for the treatment of frontal fibrosing alopecia (FFA) are limited, and the literature on treatment modalities consists mostly of case reports and cohort studies. Objectives In this review, we sought to assess the response of medical therapy for FFA and propose a clinical approach to management. Methods A literature search for “frontal fibrosing alopecia” on PubMed returned 270 items. In this review, only studies with treatment regimens and reported outcomes were considered. The majority of studies found were case reports and retrospective cohort studies. Response to therapy was assessed by reported ability to slow or arrest hair loss. Results Intralesional steroids and 5α-reductase inhibitors were the most commonly used therapies with the most positive treatment responses (88%, 181/204 for intralesional steroids and 88%, 158/180 for 5α-reductase inhibitors). Oral prednisone was seldom used and only temporarily delayed rapid hair loss. Other therapies evaluated included topical steroids, antibiotics, pioglitazone, systemic retinoids, and hair transplantation. Limitations Lack of placebo control studies and uniform outcome measures. Conclusion The natural course of FFA is variable. Recession of the frontal hairline might stabilize regardless of treatment. However, early intervention is encouraged in active disease because hair loss is presumed permanent and treatment could modify the disease course.