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  • Presentation

Frontal Fibrosing Alopecia: My Approach

Description

In a lecture on Frontal Fibrosing Alopecia (FFA), the speaker shared insights into the complexity and multifaceted nature of the condition, which primarily affects the hairline of menopausal women but can also impact other body hair. Emphasizing that irreversible hair loss occurs due to scarring, the speaker advocated for a tailored therapeutic approach comprising systemic, topical, and sometimes intralesional treatments. There remains no consensus on the best treatments due to the lack of clinical trials; however, both hydroxychloroquine and dutasteride are commonly used. The speaker highlighted the importance of monitoring disease activity, recommending trichoscopy but cautioning against over-relying on scaling as an indicator. For associated features like eyebrow and facial hair loss, topical medications and isotretinoin were discussed. The speaker also presented strategies for managing symptoms like scalp discomfort, suggesting low-dose naltrexone. Recommendations for FFA patients included avoiding all sunscreens and being cautious with hair treatments, as some chemicals may exacerbate the condition. Regular follow-ups every three months are crucial for assessing hair loss progression. A new tool, Tricolab studio, was introduced to help standardize clinical assessments. In summary, treating FFA is intricate and requires a personalized approach with continuous monitoring.

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Conclusions

  • Frontal fibrosing alopecia (FFA) is a complex and multifaceted disease that goes beyond hairline loss affecting various body hair and skin features.
  • Treatment for FFA requires a combination of systemic, topical, and intralesional therapies tailored to each patient's unique symptoms and disease progression.
  • There is no single medication that addresses all features of FFA, necessitating a combination treatment regimen.
  • Hydroxychloroquine and dutasteride are often considered foundational treatments for hair loss associated with FFA, but methotrexate may be used as a second-line option if initial treatments fail.
  • Intralesional steroids can be effective for early eyebrow loss in FFA, while oral minoxidil has shown potential in improving eyebrow thickness.
  • Facial papules associated with FFA can be effectively treated with isotretinoin, particularly with an initial loading dose followed by maintenance therapy.
  • Lichen planus pigmentosus related to FFA requires simultaneous treatment for both inflammation and pigment issues, often managed with methotrexate and laser therapy.
  • Monitoring hair loss progression in FFA should not rely solely on trichoscopic scaling as there can be discordance between inflammation and hair loss, necessitating standardized clinical evaluations.
  • Patients are encouraged to avoid certain skin treatments and to follow specific recommendations regarding their hair care to mitigate further hair loss risk.
  • Bimatoprost 0,03% (Lumigan) eyebrow regrowth in frontal fibrosing alopecia: a case report.
  • Eyebrow regrowth in patients with frontal fibrosing alopecia treated with low dose oral minoxidil. Authors: Rodrigo Pirmez, MD, Leonardo Spagnol Abraham, MD, MSc.
  • Successful Treatment of Facial Papules in Frontal Fibrosing Alopecia with Oral Isotretinoin by Danielle C. Quintella Tullia Cuzzi.
  • Efficacy and safety of toning technique 1064 nm Q-switched Nd:YAG laser in lichen planus pigmentosus associated with frontal fibrosing alopecia: An open-label prospective study by Maria S. C. Garcia et al.
  • Novel Treatment Using Low-Dose Naltrexone for Lichen Planopilaris by Strazzulla LC, Avila L, Lo Sicco K, Shapiro J. J Drugs Dermatol. 2017.