Treatment of Frontal Fibrosing Alopecia and Lichen Planopilaris

Abstract

The aim of the treatment in frontal fibrosing alopecia and lichen planopilaris is to alleviate symptoms and to arrest the progression of the hair loss, since hair regrowth is not possible once the destruction of hair follicle has happened. Topical corticosteroids and tacrolimus are used to reduce inflammation, but with no clear benefit in slowing the alopecia. Intralesional corticosteroids may obtain hair regrowth in some patients, and they are especially useful in the treatment of eyebrow alopecia in frontal fibrosing alopecia. Regarding systemic treatments, the use of 5-alpha reductase inhibitors has been shown to be the most effective one to get stabilization in frontal fibrosing alopecia and even regrowth in the hairline. Hydroxychloroquine and oral immunomodulators are especially helpful as oral treatment in lichen planopilaris. Low-dose oral isotretinoin is the preferred treatment for facial papules in frontal fibrosing alopecia. The combination of oral and topical treatments is the best therapeutic choice.