Hair Transplantation for Frontal Fibrosing Alopecia: Part of the Solution?

The document discusses the challenges of treating Frontal Fibrosing Alopecia (FFA), a common type of Primary Cicatricial Alopecias (PCA), which is characterized by irreversible damage to hair follicle stem cells due to persistent inflammation. Medical treatments for FFA, such as intralesional triamcinolone acetonide, finasteride, dutasteride, corticosteroids, and antimalarials, have weak evidence-based recommendations and are often ineffective in reversing hair loss. Hair transplantation has been considered for FFA, but studies show that more than 50% of transplanted hairs are lost after 3 years, indicating that FFA exhibits recipient dominance. A successful case with 6 years follow-up involved maintenance therapy with systemic finasteride and topical minoxidil post-transplant. The authors suggest that hair transplantation for FFA should only be considered after a period of no disease activity, recommending a minimum of 2 years of clinical stability before surgery. Post-transplant, patients should continue medical treatment to maintain the transplanted hair and prevent further alopecia progression. Maintenance treatments could include clobetasol propionate lotion, topical calcineurin inhibitors, or systemic finasteride with topical minoxidil, especially if androgenetic alopecia is also present. Frequent follow-up visits are crucial, and more aggressive anti-inflammatory therapy should be initiated in case of clinical relapse. The authors emphasize that post-transplant medical therapy is critical for the success of hair transplantation in FFA patients.