Conflict of interest
Treatment of frontal fibrosing alopecia and lichen planopilaris: a systematic review
Article first published online: 26 MAR 2013
© 2013 The Authors Journal of the European Academy of Dermatology and Venereology © 2013 European Academy of Dermatology and Venereology
Journal of the European Academy of Dermatology and Venereology
Volume 27, Issue 12, pages 1461–1470, December 2013
How to Cite
Rácz, E., Gho, C., Moorman, P.W., Noordhoek Hegt, V. and Neumann, H.A.M. (2013), Treatment of frontal fibrosing alopecia and lichen planopilaris: a systematic review. Journal of the European Academy of Dermatology and Venereology, 27: 1461–1470. doi: 10.1111/jdv.12139
The authors declare to have no conflict of interest.
- Issue published online: 21 NOV 2013
- Article first published online: 26 MAR 2013
- Manuscript Accepted: 18 FEB 2013
- Manuscript Received: 24 SEP 2012
Frontal fibrosing alopecia (FFA) is a primary lymphocytic cicatricial alopecia with characteristic clinical pattern of progressive frontotemporal hairline recession, perifollicular erythema and hyperkeratosis and symptoms of itch and burning, occurring mainly in post-menopausal women. FFA is considered a subtype of lichen planopilaris (LPP), based on their identical histopathology. Currently, no evidence-based treatment is available for FFA. Our aim was to determine the effectiveness of available treatment options for FFA, and to identify promising treatment options for future studies. For this, literature search was conducted to find all primary studies on the treatment of FFA and LPP. From the primary studies, data were subtracted and analysed. No randomized controlled trials were found, and one controlled trial. Treatment of 114 patients is described in the literature. They received 10 different regimes, of which oral 5-alpha-reductase inhibitors were provided most often, resulting in good clinical response in 45% of them. Hydroxychloroquine resulted in good clinical response in 30% of the 29 treated patients. Topical corticosteroid preparations are ineffective in FFA. The remaining treatments were all reported in less than 10 patients. For the treatment of LPP, topical corticosteroid preparations are the first line of treatment, followed by oral cyclosporine and systemic corticosteroids, although they are characterized by a high relapse rate. Summarizing, there is currently no effective treatment of FFA, the most effective being oral 5-alpha-reductase inhibitors that possibly affect the accompanying androgenetic alopecia. We argue that oral cyclosporine A might be a good candidate for future studies on the treatment of FFA.