Tratamiento medico de la AFF

 Published in Dermatology

Journal Scan / Review · May 03, 2019

Medical Therapy for Frontal Fibrosing Alopecia

Journal of the American Academy of Dermatology

Abstract

BACKGROUND

Guidelines for the treatment of frontal fibrosing alopecia (FFA) are limited and literature on treatment modalities consists mostly of case reports and cohort studies.

OBJECTIVES

In this review, we sought to assess the response of medical therapy for FFA and propose a clinical approach to management.

METHODS

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.

RESULTS

Intralesional steroids and 5α-reductase inhibitors were the most commonly used therapies and had the most positive treatment responses in 88% (181/204) and 88% (158/180), respectively. Oral prednisone was seldom used and only temporarily delayed rapid hair loss. Other therapies evaluated include topical steroids, antibiotics, pioglitazone, systemic retinoids and hair transplantation.

LIMITATIONS

Lack of placebo control studies and uniform outcome measures.

CONCLUSION

The natural course of FFA is variable. Recession of the frontal hairline may stabilize regardless of treatment. However, early intervention is encouraged in active disease as hair loss is presumed permanent and treatment may modify the disease course.

Journal of the American Academy of Dermatology

Medical Therapy for Frontal Fibrosing Alopecia: A Review and Clinical Approach

J Am Acad Dermatol 2019 Apr 03;[EPub Ahead of Print], A Ho, J Shapiro 

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

TAKE-HOME MESSAGE

• This is a review of evidence of medical therapy for frontal fibrosing alopecia (FFA). A management approach is also discussed. Therapies that were used most commonly and that were associated with the highest treatment responses included intralesional steroids (181/204; 88% of studies) and 5α-reductase inhibitors (158/180; 88% of studies). Oral prednisone was found to only temporarily delay rapid hair loss. Other therapies included topical steroids, antibiotics, pioglitazone, systemic retinoids, and hair transplantation.

• The authors concluded that, although the natural course of FFA may be variable, loss of frontal hair can be stabilized irrespective of treatment. Therefore, early intervention may modify the disease course and mitigate permanent hair loss.

– InYoung Kim, MD, PhD