5-Alpha-Reductase Inhibitor Treatment for Frontal Fibrosing Alopecia: An Evidence-Based Treatment Update

March 2018 in “ JEADV. Journal of the European Academy of Dermatology and Venereology/Journal of the European Academy of Dermatology and Venereology ”

Aizuri Murad, Wilma F. Bergfeld

5-alpha-reductase inhibitors finasteride dutasteride frontal fibrosing alopecia disease stabilization hair regrowth adverse effects malignancy sexual issues psychiatric issues 5ARI Propecia Avodart FFA

TLDR 5-alpha-reductase inhibitors may help stabilize or slow down hair loss in some frontal fibrosing alopecia patients, but more research is needed to confirm their effectiveness and safety.

The review analyzed the efficacy and safety of 5-alpha-reductase inhibitors (5ARI), specifically finasteride and dutasteride, in treating frontal fibrosing alopecia (FFA). It included 14 studies with 270 patients, showing that dutasteride was more effective, with disease stabilization in 37.3% to 55.6% of patients and some hair regrowth, while finasteride showed disease stabilization in 47% to 52.9% of patients and minimal hair regrowth in 32.1% of cases. Despite positive outcomes, the use of 5ARI remained off-label with concerns about long-term safety, especially in women. The review emphasized the need for randomized, double-blind, placebo-controlled studies to confirm 5ARI's efficacy and highlighted potential adverse effects, including malignancy, sexual, and psychiatric issues.

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Research cited in this study

17 / 17 results

research Frontal Fibrosing Alopecia: Clinical and Prognostic Classification

74 citations, April 2017 in “JEADV. Journal of the European Academy of Dermatology and Venereology/Journal of the European Academy of Dermatology and Venereology”

Researchers found three patterns of Frontal fibrosing alopecia, with Pattern III having the best prognosis after treatment.

research Prevalence of Hormonal and Endocrine Dysfunction in Patients with Lichen Planopilaris: A Retrospective Data Analysis of 168 Patients

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Lichen planopilaris (LPP) is linked to androgen excess, while frontal fibrosing alopecia (FFA) is linked to androgen deficiency.

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Treatment with dutasteride, minoxidil, and artificial hair transplantation improved appearance but caused folliculitis.

research Investigation of the Plausibility of 5-Alpha-Reductase Inhibitor Syndrome

33 citations, January 2016 in “Skin appendage disorders”

The document concludes that sexual and psychiatric side effects from 5-alpha-reductase inhibitors are reported, but more high-quality research is needed to understand how often they occur.

research Finasteride-Mediated Hair Regrowth and Reversal of Atrophy in a Patient with Frontal Fibrosing Alopecia

24 citations, September 2015 in “JAAD case reports”

Finasteride helps hair regrowth in frontal fibrosing alopecia.

research Frontal Fibrosing Alopecia: A Multicenter Review of 355 Patients

339 citations, February 2014 in “Journal of The American Academy of Dermatology”

Most patients with frontal fibrosing alopecia are postmenopausal women, and treatments like finasteride and dutasteride can improve or stabilize the condition.

research Frontal Fibrosing Alopecia: A Retrospective Review of 19 Patients Seen at Duke University

98 citations, February 2013 in “Journal of The American Academy of Dermatology”

Dutasteride may help stabilize Frontal Fibrosing Alopecia, but more research is needed.

research Finasteride 5 mg/Day Treatment of Patterned Hair Loss in Normo-Androgenetic Postmenopausal Women

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Finasteride 5 mg/day effectively treats hair loss in postmenopausal women without hyper-androgenism.

research Treatment of Postmenopausal Frontal Fibrosing Alopecia with Oral Dutasteride

64 citations, June 2009 in “Journal of The American Academy of Dermatology”

Oral dutasteride can potentially treat frontal fibrosing alopecia in postmenopausal women, with some patients showing disease arrest and hair regrowth.

research Frontal Fibrosing Alopecia: Treatment with Oral Dutasteride and Topical Pimecrolimus

69 citations, August 2008 in “Journal of The European Academy of Dermatology and Venereology”

Oral dutasteride and topical pimecrolimus can safely and effectively treat Frontal Fibrosing Alopecia, leading to significant hair regrowth.

research Effect of Finasteride 5 mg (Proscar) on Acne and Alopecia in Female Patients with Normal Serum Levels of Free Testosterone

43 citations, January 2007 in “Gynecological Endocrinology”

Finasteride improves acne and hair loss in women with normal testosterone.

research Frontal Fibrosing Alopecia: A Survey in 16 Patients

123 citations, August 2005 in “Journal of the European Academy of Dermatology and Venereology”

The study found that Frontal Fibrosing Alopecia affects a broader age range of women and early treatment can help stop hair loss.

research Frontal Fibrosing Alopecia in Postmenopausal Women

179 citations, December 2004 in “Journal of The American Academy of Dermatology”

Some postmenopausal women with frontal fibrosing alopecia stopped losing hair with finasteride treatment, hinting at a possible hormonal cause.

research Use of Cyproterone Acetate, Finasteride, and Spironolactone to Treat Idiopathic Hirsutism

56 citations, April 2003 in “Fertility and Sterility”

All three treatments reduce hirsutism, but spironolactone works best long-term.

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88 citations, October 2002 in “Journal of Dermatology”

Finasteride for hair loss may cause depression, affecting sleep and relationships.

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100 citations, September 1999 in “British Journal of Dermatology”

The study found that two enzymes linked to hair loss are located in different parts of the scalp, supporting a common treatment's effectiveness.

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70 citations, August 1995 in “Fertility and Sterility”

Finasteride reduces hairiness and androgen levels in women with unexplained excessive hair growth.

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community Testosterone and hair loss seeming irrelevance

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The conversation is about the role of testosterone in hair loss and the effectiveness of different treatments. The conclusion is that DHT is the main culprit for hair loss, and finasteride has been proven to work long-term in maintaining and regrowing hair. Testosterone may have a minor effect, but it is not the primary cause of hair loss.

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community Spironolactone for 11 years, finasteride for almost 5 years, started oral minoxidil in November 😢 ended oral contraceptive in Dec.

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