Reply to 'Facial Papules in Frontal Fibrosing Alopecia: Good Response to Isotretinoin'

The document discusses the treatment of facial papules (FP) in patients with frontal fibrosing alopecia (FFA) using isotretinoin. It references a report by Flores-Terry et al. about two Spanish female patients with yellow FP of FFA who were treated with a fixed low dose of isotretinoin (10 mg/day), with one showing excellent response after 1 month and the other showing improvement after 1.5 months. The authors of the document found three published papers that reported successful use of low dose isotretinoin in FP in FFA/Lichen plano-pilaris (LPP), including a study of 62 patients. They highlight that FFA is a variant of LPP affecting the frontotemporal hairline and that FP are associated with the disease. The document also mentions a study by Pirmez et al. involving three female patients with biopsy-confirmed FFA who were treated with isotretinoin and showed remarkable improvement. Additionally, Pedrosa et al. followed 108 patients with FFA, 62 of whom exhibited yellow FP, and found that low-dose isotretinoin led to a reduction in yellow FP and skin roughness. The document concludes that both simple and yellow FP are responsive to low-dose isotretinoin, and the report by Flores-Terry et al. adds two more cases to the evidence supporting the efficacy of very low doses of isotretinoin in treating yellow FP of FFA.