Reply to 'Frontal Fibrosing Alopecia'

The document is a reply to a letter regarding a study on Frontal Fibrosing Alopecia (FFA). The authors, Sergio Vaño-Galván and colleagues, address several points raised by Susan Holmes and Alison MacDonald. They clarify that smoking does not appear to trigger or protect against FFA, based on their study and Holmes and MacDonald's study. They suggest hormonal imbalance, particularly in postmenopausal women, may play a role in FFA's pathogenesis, but acknowledge that this does not explain all cases. They also discuss the difficulty in assessing treatment response, noting that while hair regrowth was minimal, stabilization of the condition was achieved in some patients. Specifically, they highlight that antiandrogenic drugs were used in 111 of 355 patients (31%), with stabilization observed in all cases and improvement in 28 patients (25.2%) who did not receive other treatments. They conclude that while spontaneous stabilization is possible, it is unlikely to account for all observed cases of stabilization. The authors agree with Holmes and MacDonald that randomized controlled trials with validated assessment tools are needed to confirm treatment efficacy, but in the meantime, a combination of antiandrogens and intralesional steroids seems to be an effective strategy for achieving stabilization in FFA patients.