Frontal Fibrosing Alopecia: To Treat or Not to Treat?

Abstract

Background: Published studies have evaluated a variety of therapeutic agents in frontal fibrosing alopecia (FFA); however, data on whether fibrosis is already established when the patients initially present are scarce. Objective: To identify the prevalence of active disease in patients initially diagnosed with FFA and to evaluate the efficacy of therapeutic agents suggested in the medical literature. Patients/Methods: Eighteen postmenopausal women with FFA presented at the outpatient clinic of our hospital from June 2003 to August 2007. Five patients who also presented with androgenetic alopecia were treated with finasteride 2.5 mg/d plus minoxidil 5% for 12 months. One patient with a rapidly regressing disease received systemic corticosteroids. The remaining 12 patients were divided into two groups: 6 patients received topical clobetasol 0.05% solution once daily for 6 months and the rest received no treatment. Results: Thirteen of 18 patients presented with stable disease. No significant improvement was observed in any of the patients. Conclusion: To date, there is no effective treatment proven with an appropriate level of evidence in the management of FFA. Exclusion criteria in future clinical studies should take into account patients presenting with stable disease. What needs to be established is whether treatment can halt or slow the progression of active disease.