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

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.