Department of Dermatology and Venereology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
J Eur Acad Dermatol Venereol. 2013 Dec;27(12):1461-70. doi: 10.1111/jdv.12139. Epub 2013 Mar 26.
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.
额部纤维性脱发(FFA)是一种以进行性额颞部发际线后退、毛囊周围红斑和角化过度为特征的原发性淋巴细胞性瘢痕性脱发,伴有瘙痒和烧灼感等症状,主要发生在绝经后妇女中。FFA 被认为是扁平苔藓样瘢痕性脱发(LPP)的一种亚型,基于其相同的组织病理学。目前,尚无针对 FFA 的循证治疗方法。我们的目的是确定针对 FFA 的现有治疗选择的有效性,并确定未来研究中有希望的治疗选择。为此,我们进行了文献检索,以查找所有关于 FFA 和 LPP 治疗的原始研究。从原始研究中,我们减去并分析了数据。我们没有发现随机对照试验,只有一项对照试验。文献中描述了对 114 名患者的治疗。他们接受了 10 种不同的治疗方案,其中最常使用口服 5-α-还原酶抑制剂,其中 45%的患者获得了良好的临床反应。羟氯喹在 29 例接受治疗的患者中使 30%的患者获得了良好的临床反应。局部皮质类固醇制剂在 FFA 中无效。其余的治疗方法均在少于 10 名患者中报道。对于 LPP 的治疗,局部皮质类固醇制剂是一线治疗方法,其次是口服环孢素和全身皮质类固醇,尽管它们的复发率很高。总之,目前没有有效的 FFA 治疗方法,最有效的是口服 5-α-还原酶抑制剂,可能会影响伴随的雄激素性脱发。我们认为,口服环孢素 A 可能是未来 FFA 治疗研究的一个很好的候选药物。