From the Guidelines
Hydroxychloroquine should be used with caution in the treatment of frontal fibrosing alopecia, with a typical dosage of 200 mg twice daily, and thorough pre-treatment monitoring investigations including a baseline electrocardiogram and ophthalmologic examination to screen for QT prolongation and retinal toxicity. When considering hydroxychloroquine for frontal fibrosing alopecia, it is essential to weigh the potential benefits against the risks, particularly given the lack of direct evidence for its use in this condition 1.
- Pre-treatment monitoring investigations should include:
- Baseline electrocardiogram to screen for QT prolongation
- Ophthalmologic examination using newer testing modalities such as multifocal electroretinography and spectral domain optical coherence tomography to rule out macular disease
- The dosage of hydroxychloroquine is typically 200 mg twice daily (5 mg/kg), as indicated for cutaneous manifestations of other conditions 1.
- Follow-up investigations should include:
- Annual ophthalmologic screening starting 5 years or less after initiation of the drug if the patient is still taking hydroxychloroquine and has underlying risk factors for retinal toxicity
- Regular monitoring of side effects, including gastrointestinal disturbances, skin rashes, and rare but serious ocular toxicity
- The duration of treatment is not well established for frontal fibrosing alopecia, but it is crucial to assess clinical response at regular intervals, typically every 3-6 months, and consider discontinuing or changing therapy if no improvement is observed after 6 months.
- Patients should be informed about potential side effects and the importance of sun protection during treatment, as hydroxychloroquine can cause photosensitivity. Given the potential risks and benefits, hydroxychloroquine should be used as a second-line treatment for frontal fibrosing alopecia, with careful monitoring and consideration of alternative therapies if necessary 1.
From the Research
Protocol for Using Hydroxychloroquine in Frontal Fibrosing Alopecia
- The dosage of hydroxychloroquine used in the treatment of frontal fibrosing alopecia is 400 mg/day 2, 3, 4.
- The duration of treatment with hydroxychloroquine can vary, but studies have shown significant improvements in disease activity after 6 and 12 months of therapy 2, 3.
- Pre-treatment monitoring investigations and follow-up investigations are not explicitly stated in the provided studies, but it is recommended to monitor for adverse events and assess treatment response using the Lichen Planopilaris Activity Index (LPPAI) or the Frontal Fibrosing Alopecia Severity Score (FFASS) 2, 3, 4.
- Hydroxychloroquine can be used as a first-line systemic treatment for frontal fibrosing alopecia, and its efficacy is comparable to that of finasteride 4.
- Treatment with hydroxychloroquine can lead to clinical stabilization, but the variable course of the disease and the possibility of spontaneous stabilization make it difficult to determine the true effectiveness of the treatment 5.
Treatment Efficacy and Safety
- Hydroxychloroquine has been shown to be effective in reducing signs and symptoms of frontal fibrosing alopecia, with significant improvements in disease activity after 6 and 12 months of treatment 2, 3.
- The treatment is generally well-tolerated, but adverse events should be monitored 2, 3.
- The efficacy of hydroxychloroquine in treating frontal fibrosing alopecia is comparable to that of other treatments, such as finasteride and methotrexate 4, 6, 5.
Comparison with Other Treatments
- Hydroxychloroquine has been compared to finasteride in a randomized controlled trial, and both treatments were found to be equally effective and safe 4.
- Other treatments, such as methotrexate, have also been used to treat frontal fibrosing alopecia, but more studies are needed to determine their efficacy and safety 6, 5.