What is the best treatment approach for a patient with sarcoidosis and frontal fibrosing alopecia?

From the Guidelines

The best treatment approach for a patient with sarcoidosis and frontal fibrosing alopecia (FFA) is a combination of oral hydroxychloroquine (200-400 mg daily) and topical corticosteroids, with consideration of systemic corticosteroids, immunosuppressants, and platelet-rich plasma (PRP) therapy for refractory cases, as supported by recent studies 1.

Treatment Overview

The management of sarcoidosis and FFA requires a multifaceted approach, addressing both conditions simultaneously to minimize morbidity, mortality, and improve quality of life.

• Oral hydroxychloroquine is often the first-line treatment due to its ability to address both conditions, with a recommended dose of 200-400 mg daily.
• Topical corticosteroids, such as clobetasol propionate 0.05%, applied to the affected scalp areas once or twice daily, can help manage localized inflammation.
• For patients with more severe or progressive disease, systemic corticosteroids like prednisone (20-40 mg daily, tapered over several months) may be necessary, as suggested by the Delphi consensus recommendations 1.
• Additional options include intralesional corticosteroid injections (triamcinolone acetonide 5-10 mg/ml) for localized areas and immunosuppressants such as methotrexate (7.5-25 mg weekly) or mycophenolate mofetil (1-2 g daily) for refractory cases, as indicated by the European Respiratory Journal guidelines 1.
• Minoxidil 5% solution may help with hair regrowth in FFA-affected areas, and its combination with PRP therapy has shown promising results in treating androgenetic alopecia, as reported in the study on autologous platelet concentrates in aesthetic medicine 1.

Monitoring and Adjustment

Regular monitoring every 3-6 months is essential to assess treatment response and adjust therapy accordingly, with particular attention to potential side effects of medications like hydroxychloroquine, which requires baseline and periodic ophthalmologic examinations. The treatment algorithm for symptomatic or organ-threatening sarcoidosis, as proposed by the Delphi consensus recommendations 1, should be considered in the management of these patients.

• The use of PRP therapy, as discussed in the study on autologous platelet concentrates in aesthetic medicine 1, may offer an additional treatment option for patients with refractory FFA.
• The European Respiratory Journal guidelines 1 emphasize the importance of considering the diverse nature of sarcoidosis and the need for individualized treatment decisions based on organ involvement, risk for significant morbidity, and impact on quality of life.

By prioritizing the most recent and highest-quality studies, such as the 2025 study on autologous platelet concentrates in aesthetic medicine 1, and considering the Delphi consensus recommendations 1 and European Respiratory Journal guidelines 1, healthcare providers can develop an effective treatment plan for patients with sarcoidosis and FFA, minimizing morbidity, mortality, and improving quality of life.

From the Research

Treatment Approaches for Frontal Fibrosing Alopecia

• The most effective treatment options for frontal fibrosing alopecia (FFA) include 5-α-reductase inhibitors, intralesional steroids, and hydroxychloroquine, as reported in studies 2, 3, 4.
• Dutasteride, a 5-α-reductase inhibitor, has been shown to be effective in stabilizing hairline recession in patients with FFA, with a dose-dependent response 5.
• Intralesional steroids and 5α-reductase inhibitors have been found to have the most positive treatment responses, with an 88% response rate in some studies 3.
• Hydroxychloroquine has also been found to be effective in reducing signs and symptoms of FFA, with a statistically significant reduction in symptoms at 6- and 12-month follow-up 4.

Considerations for Patients with Sarcoidosis

• There is limited information available on the treatment of FFA in patients with sarcoidosis, and further research is needed to determine the best treatment approach for this population.
• However, the treatment options mentioned above (5-α-reductase inhibitors, intralesional steroids, and hydroxychloroquine) may still be considered for patients with FFA and sarcoidosis, as they have been shown to be effective in treating FFA in general 5, 2, 3, 4.
• It is essential to monitor patients with sarcoidosis closely, as they may be more prone to adverse effects from certain medications, and adjust the treatment plan accordingly.

Additional Treatment Options

• Other treatment options that have been used for FFA include topical steroids, antibiotics, pioglitazone, systemic retinoids, and hair transplantation, although the evidence for these treatments is limited and variable 2, 3.
• Further research is needed to determine the efficacy of these treatments and to develop more effective treatment options for FFA.