Lichen Planopilaris and Frontal Fibrosing Alopecia: Review and Update of Diagnostic and Therapeutic Features

April 2022 in “ Anais brasileiros de dermatologia/Anais Brasileiros de Dermatologia ”

Carolina Oliveira Costa Fechine, Neusa Yuriko Sakai Valente, Ricardo Romiti

Lichen planopilaris Frontal fibrosing alopecia scarring alopecia scalp biopsy systemic retinoids finasteride PPAR-gamma agonists naltrexone diode laser devices hair transplant surgery Propecia hair transplant

From the encyclopedia

Finasteride →

Frontline, gold standard treatment for combatting androgenic alopecia

Naltrexone →

Hair Transplant →

Hair transplantation moves DHT-resistant follicles from a donor area (back and sides of the scalp) into thinning or bald areas. The transplanted hair is generally permanent, though surrounding native hair can keep thinning.

Studysummary This comprehensive literature review highlighted that lichen planopilaris and frontal fibrosing alopecia, both primary scarring alopecias, are diagnosed via scalp biopsy, with no standardized treatments available, necessitating individualized therapeutic approaches based on patient characteristics. Our plain-language summary of this paper — not a Tressless recommendation.

The document reviews the diagnostic and therapeutic features of Lichen planopilaris (LPP) and Frontal fibrosing alopecia (FFA), two types of scarring alopecia. Diagnosis is typically confirmed through a scalp biopsy, with FFA considered a variant of LPP due to similar histopathological findings. There are no validated treatments or guidelines, with recommendations varying based on individual patient characteristics. Various treatments are discussed, including systemic retinoids, which showed disease stabilization in 79% and 73% of patients respectively, compared to 43% in the finasteride group. Other treatments include PPAR-gamma agonists, naltrexone, diode laser devices, and hair transplant surgery. However, the lack of randomized clinical trials prevents definitive conclusions about the most effective treatments. The document emphasizes the need for more research to establish effective treatments for both conditions.

View this study on sciencedirect.com →

Discuss this study in the Community →

Research cited in this study

28 / 28 results

research Association of Inflammation With Progression of Hair Loss in Women With Frontal Fibrosing Alopecia

16 citations , April 2020 in “JAMA dermatology”

More inflammation leads to faster and worse hair loss in women with frontal fibrosing alopecia.

research Oral Minoxidil Improves Background Hair Thickness in Lichen Planopilaris

15 citations , April 2020 in “Journal of The American Academy of Dermatology”

This article discusses the challenges of treating lichen planopilaris, reviews various therapeutic options including minoxidil, and reports no new clinical findings.

research Medical Therapy for Frontal Fibrosing Alopecia: A Review and Clinical Approach

37 citations , April 2019 in “Journal of The American Academy of Dermatology”

This review assessed the effectiveness of various treatments for frontal fibrosing alopecia and found that intralesional steroids and 5α-reductase inhibitors showed the most positive outcomes in slowing or halting hair loss, though the lack of placebo-controlled studies and consistent outcome measures limits definitive conclusions.

research Frontal Fibrosing Alopecia: An Update on Pathogenesis, Diagnosis, and Treatment

61 citations , January 2019 in “American Journal of Clinical Dermatology”

This review discusses the potential causes and treatments for frontal fibrosing alopecia but reports no new clinical findings, highlighting the need for further research to understand its pathogenesis and develop validated treatments.

research Lichen Planopilaris: Retrospective Study on the Characteristics and Treatment of 291 Patients

48 citations , November 2018 in “Journal of dermatological treatment”

In a study reviewing 291 patients with lichen planopilaris, findings revealed that women were more commonly affected than men, cyclosporine and methotrexate were most effective in achieving remission, and 5-alpha reductase inhibitors and systemic retinoids were particularly beneficial for frontal fibrosing alopecia.

research Tofacitinib for the Treatment of Lichen Planopilaris: A Case Series

79 citations , September 2018 in “Dermatologic therapy”

This study found that treatment with oral tofacitinib, alone or with other therapies, was associated with clinical improvement in most patients with recalcitrant lichen planopilaris.

research Frontal Fibrosing Alopecia: A Retrospective Analysis of 72 Patients from a German Academic Center

25 citations , December 2017 in “Facial Plastic Surgery”

This study observed that combining high-potency steroids with pimecrolimus might effectively stabilize hairline recession in frontal fibrosing alopecia patients.

research Prognosis, Treatment, and Disease Outcomes in Frontal Fibrosing Alopecia: A Retrospective Review of 92 Cases

36 citations , December 2017 in “Journal of the American Academy of Dermatology”

This study observed that 70.7% of patients with frontal fibrosing alopecia stabilized with treatment, and patients using 0.3% tacrolimus were more likely to stabilize in 3 months compared to other treatments.

research Updated Diagnostic Criteria for Frontal Fibrosing Alopecia

30 citations , December 2017 in “Journal of The American Academy of Dermatology”

This correspondence discusses proposed updates to the diagnostic criteria for frontal fibrosing alopecia, emphasizing the importance of differentiating it from other types of alopecia.

research Novel Treatment Using Low-Dose Naltrexone for Lichen Planopilaris

39 citations , November 2017 in “PubMed”

This case series reported that low-dose naltrexone may benefit patients with lichen planopilaris by reducing scalp symptoms and slowing disease progression, with no adverse effects observed in the patients.

research Efficacy of Isotretinoin and Acitretin in Treatment of Frontal Fibrosing Alopecia: Retrospective Analysis of 54 Cases

26 citations , October 2017 in “PubMed”

According to this study, systemic retinoids, specifically oral isotretinoin and acitretin, were more effective than finasteride in stabilizing the frontal hairline in female patients with frontal fibrosing alopecia, achieving treatment goals in over 70% of cases.

research Frontal Fibrosing Alopecia: Clinical and Prognostic Classification

74 citations , April 2017 in “JEADV. Journal of the European Academy of Dermatology and Venereology/Journal of the European Academy of Dermatology and Venereology”

This study classified frontal fibrosing alopecia patients into three clinical patterns, finding that pattern III had the best prognosis and pattern II the worst after treatment with dutasteride and corticosteroids.

research Antiandrogenic Drugs: A Therapeutic Option for Frontal Fibrosing Alopecia Patients

10 citations , March 2016 in “Journal of The American Academy of Dermatology”

This review discusses the potential usefulness and safety profile of oral antiandrogens for treating frontal fibrosing alopecia, noting possible benefits but acknowledges that finasteride's efficacy remains uncertain.

research Finasteride-Mediated Hair Regrowth and Reversal of Atrophy in a Patient with Frontal Fibrosing Alopecia

24 citations , September 2015 in “JAAD case reports”

This case report describes a patient with frontal fibrosing alopecia experiencing significant hair regrowth and reversal of cutaneous atrophy after treatment with the 5α-reductase inhibitor finasteride.

research The Use of Oral Pioglitazone in the Treatment of Lichen Planopilaris

58 citations , January 2015 in “Journal of the American Academy of Dermatology”

Pioglitazone may help treat lichen planopilaris, but more research is needed.

research A Case Series of 46 Patients With Lichen Planopilaris: Demographics, Clinical Evaluation, and Treatment Experience

47 citations , June 2014 in “Journal of Dermatological Treatment”

This retrospective review found that while intralesional corticosteroids provided symptomatic improvement for lichen planopilaris, hydroxychloroquine with topical corticosteroids led to higher remission rates but did not result in visible hair regrowth.

research Frontal Fibrosing Alopecia: A Retrospective Clinical Review of 62 Patients with Treatment Outcome and Long-Term Follow-Up

102 citations , April 2014 in “International Journal of Dermatology”

This study found that early intervention and treatment with intralesional triamcinolone acetonide may stabilize hairline recession in patients with frontal fibrosing alopecia, although further research is needed for definitive treatment guidelines.

research Frontal Fibrosing Alopecia: A Multicenter Review of 355 Patients

339 citations , February 2014 in “Journal of The American Academy of Dermatology”

This study found that eyelash loss, facial papules, and body hair involvement were linked to severe frontal fibrosing alopecia, and antiandrogens were the most effective treatment.

research Frontal Fibrosing Alopecia: A Review of 60 Cases

166 citations , April 2012 in “Journal of The American Academy of Dermatology”

This study reviewed clinical data from 60 patients with frontal fibrosing alopecia and found increasing prevalence and generally poor response to treatment, with the cause remaining unclear.

research Dermoscopy-Guided Scalp Biopsy in Cicatricial Alopecia

62 citations , March 2012 in “Journal of the European Academy of Dermatology and Venereology”

This study found that dermoscopy-guided scalp biopsies provided a definitive pathological diagnosis in 95% of patients with cicatricial alopecia.

research Eyebrow Regrowth in Patients with Frontal Fibrosing Alopecia Treated with Intralesional Triamcinolone Acetonide

51 citations , August 2010 in “British journal of dermatology/British journal of dermatology, Supplement”

In this study, intralesional triamcinolone acetonide was associated with eyebrow regrowth in some patients with frontal fibrosing alopecia.

research Frontal Fibrosing Alopecia: A Clinical Review of 36 Patients

159 citations , August 2010 in “British journal of dermatology/British journal of dermatology, Supplement”

In this study, hydroxychloroquine significantly reduced signs and symptoms of frontal fibrosing alopecia after 6 months of treatment, with maximal benefits observed within the first 6 months.

research Commentary: Treatment of Lichen Planopilaris

23 citations , January 2010 in “Journal of The American Academy of Dermatology”

This article discusses the efficacy and safety of mycophenolate mofetil and hydroxychloroquine for treating lichen planopilaris and reports no new clinical results.