Ronald O. Perelman Department of Dermatology, New York University, New York, New York.
Ronald O. Perelman Department of Dermatology, New York University, New York, New York.
J Am Acad Dermatol. 2019 Aug;81(2):568-580. doi: 10.1016/j.jaad.2019.03.079. Epub 2019 Apr 3.
Guidelines for the treatment of frontal fibrosing alopecia (FFA) are limited, and the literature on treatment modalities consists mostly of case reports and cohort studies.
In this review, we sought to assess the response of medical therapy for FFA and propose a clinical approach to management.
A literature search for "frontal fibrosing alopecia" on PubMed returned 270 items. In this review, only studies with treatment regimens and reported outcomes were considered. The majority of studies found were case reports and retrospective cohort studies. Response to therapy was assessed by reported ability to slow or arrest hair loss.
Intralesional steroids and 5α-reductase inhibitors were the most commonly used therapies with the most positive treatment responses (88%, 181/204 for intralesional steroids and 88%, 158/180 for 5α-reductase inhibitors). Oral prednisone was seldom used and only temporarily delayed rapid hair loss. Other therapies evaluated included topical steroids, antibiotics, pioglitazone, systemic retinoids, and hair transplantation.
Lack of placebo control studies and uniform outcome measures.
The natural course of FFA is variable. Recession of the frontal hairline might stabilize regardless of treatment. However, early intervention is encouraged in active disease because hair loss is presumed permanent and treatment could modify the disease course.
目前针对额部纤维性脱发（FFA）的治疗指南有限，且有关治疗方法的文献大多为病例报告和队列研究。
本综述旨在评估 FFA 医学治疗的反应，并提出临床管理方法。
在 PubMed 上以“frontal fibrosing alopecia”为关键词进行文献检索，共检索到 270 篇文献。本综述仅纳入了有治疗方案和报告结果的研究。大多数研究为病例报告和回顾性队列研究。通过报告减缓或停止脱发的能力来评估治疗反应。
皮质内类固醇和 5α-还原酶抑制剂是最常用的治疗方法，具有最积极的治疗反应（皮质内类固醇 88%，181/204；5α-还原酶抑制剂 88%，158/180）。口服泼尼松很少使用，且仅暂时延缓快速脱发。评估的其他治疗方法包括局部皮质类固醇、抗生素、吡格列酮、全身维 A 酸和毛发移植。
缺乏安慰剂对照研究和统一的疗效评估标准。
FFA 的自然病程存在差异。尽管不进行治疗，额部发际线退缩可能会稳定。然而，由于脱发被认为是永久性的，且治疗可能会改变疾病进程，因此鼓励在疾病活跃期进行早期干预。
