Frontal Fibrosing Alopecia: Efficacy of Treatment Modalities

The document from 2019 reviews the efficacy of treatments for Frontal Fibrosing Alopecia (FFA), with a focus on 5-alpha-reductase inhibitors (5ARis), intralesional steroids, hydroxychloroquine, and other modalities like topical steroids, calcineurin inhibitors, systemic retinoids, oral antibiotics, minoxidil, excimer laser, and hair transplantation. The largest retrospective study included 120 patients and showed that 47% improved and 52.9% stabilized with finasteride, while 44.4% improved and 55.6% stabilized with dutasteride. Another study with 106 patients found that 37.3% achieved stabilization with dutasteride and topical steroids. Intralesional steroids showed a positive clinical response in 83% of 130 patients. However, the efficacy of many treatments remains uncertain due to the lack of randomized controlled trials (RCTs), and the goal of treatment is often disease stabilization rather than hair regrowth due to the scarring nature of FFA. The document concludes that more research is needed to establish effective treatment protocols and that patient selection for hair transplantation should be cautious, with low expectations due to the potential for transplantation failure.