Finasteride-mediated hair regrowth and reversal of atrophy in a patient with frontal fibrosing alopecia.

FFA: Frontal fibrosing alopecia LPP: Lichen planopilaris INTRODUCTION Frontal fibrosing alopecia (FFA) is a form of cicatricial alopecia that predominantly affects perimenopuasal and postmenopausal women. Although the precise cause is unknown, it is currently classified as a primary lymphocytic cicatricial alopecia that is closely related to lichen planopilaris (LPP). FFA not only causes scarring hair loss but also frequently causes skin atrophy within the frontal hairline. Until recently, the treatment for FFA has mirrored the treatment algorithms used for other primary lymphocytic scarring alopecias. Topical steroids, steroid injections, hydroxychloroquine, doxycycline, tetracycline and mycophenolate mofetil have been the main treatments. However, in the last few years, an increasing number of reports have suggested a beneficial role for the 5 alpha reductase inhibitory medications, finasteride and dutasteride. To date, the published studies of FFA treatment outcomes have focused on hair follicles—whether they are lost, stabilized, or promoted to regrow. The other important feature of the condition—cutaneous atrophy—has not received much attention. Here, I report a patient with FFA who experienced not only marked frontal hair regrowth with the 5a-reductase inhibitor, finasteride, but also a marked reversal of cutaneous atrophy.