Increasing Utility of Finasteride for Frontal Fibrosing Alopecia

Frontal fibrosing alopecia is a difficult condition to treat due to limited treatment options and lack of evidence for available agents. However, off-label use of finasteride, a type 2 5a-reductase inhibitor commonly used in men, has shown increasing efficacy for frontal fibrosing alopecia in women. A study involving 102 patients showed improvement in 47% and stabilization in 53% of patients. A combination strategy using finasteride and minoxidil in 8 patients halted progression of disease in 50% of patients after 12 to 18 months. The recommended starting dose of finasteride is 2.5 mg daily, with possible side effects including depression, headache, nausea, and hot flashes. If there is no improvement after 6 months, the dose of finasteride can be increased to 5 mg/d and minoxidil 2% to 5% can be added.