Frontal Fibrosing Alopecia: Successfully Treated with Methotrexate or Just the Natural Disease Progression?

A 53-year-old woman with a 3-year history of frontal fibrosing alopecia (FFA) showed no improvement with hydroxychloroquine and minoxidil but achieved clinical stabilization within 7 months of switching to methotrexate monotherapy. FFA, a cicatricial alopecia, typically affects postmenopausal Caucasian women and presents with frontotemporal hairline recession, lighter skin, and perifollicular erythema. Despite the lack of randomized clinical trials for FFA treatment, various topical and systemic drugs are used. The study highlighted the challenge of distinguishing treatment effects from natural disease progression and suggested that drug withdrawal could be considered after stabilization, though patient compliance may be difficult.