Treating Frontal Fibrosing Alopecia and Lichen Planopilaris

Conclusions

• Frontal fibrosing alopecia (FFA) and lichen planopilaris (LPP) likely have multifactorial causes, including potential allergic reactions and environmental factors.
• Patch testing shows that patients with LPP and FFA have a 2.8-fold increased risk of positive reactions compared to controls, suggesting an allergen-related component to the diseases.
• A significant proportion (45.2%) of LPP/FFA patients had allergies to fragrances, particularly to linalool, which activates immune receptors implicated in these conditions.
• Chemical sunscreens and moisturizers potentially disrupt endocrine function and may be linked to developing FFA, with evidence suggesting a twofold increased risk with consistent use.
• Topical calcineurin inhibitors (TCIs) are effective and do not cause skin atrophy, as opposed to topical steroids which can worsen atrophy and potentially hinder hair growth.
• Topical JAK inhibitors have shown promise in reducing inflammation and initiating hair regrowth in patients with FFA and LPP, with few serious side effects reported.
• Oral JAK inhibitors also yield high response rates in managing recalcitrant LPP, with the majority of side effects being mild.
• Hydroxychloroquine is a well-tolerated treatment option for LPP/FFA with good efficacy, particularly when dosing guidelines are strictly followed to minimize retinopathy risk.
• It is crucial to monitor hairline measurements over time as a key indicator of disease stability in FFA patients, rather than relying solely on subjective reports of hair loss.