Response to Effectiveness of Dutasteride in a Large Series of Patients with Frontal Fibrosing Alopecia in Real Clinical Practice
April 2021
TLDR The authors suggest that 5-α-reductase inhibitors, like dutasteride, are effective in treating frontal fibrosing alopecia and should be the first-line treatment, with other options for severe cases. They also recommend further research on Janus kinase inhibitors.
The authors of the study "Effectiveness of dutasteride in a large series of patients with frontal fibrosing alopecia in real clinical practice" responded to feedback on their work, acknowledging the unknown mechanism of 5-α-reductase inhibitors (5ARIs) in treating frontal fibrosing alopecia (FFA). They noted the potential role of hormones in FFA, given its prevalence in postmenopausal women and association with cytochrome P450 1B1 variants. The study, which compared dutasteride treatment with other options and no systemic treatment, found 5ARIs effective regardless of pre-existing female pattern hair loss. The authors acknowledged limitations due to the study's observational and retrospective design and the slow progression of FFA. They proposed a therapeutic algorithm for FFA, recommending 5ARIs as the first-line treatment, with hydroxychloroquine, doxycycline, and oral retinoids for patients with severe inflammation or progression despite 5ARIs. They also suggested future exploration of Janus kinase inhibitors. The authors concluded that 5ARIs currently have the highest level of evidence for benefiting FFA patients.
