From the Research
The use of isotretinoin in combination with hydroxychloroquine and 5-alpha reductase inhibitors for frontal fibrosing alopecia (FFA) is not supported by robust clinical trials, but a recent study suggests that oral isotretinoin combined with topical treatments may be effective in improving FFA severity. Based on the most recent and highest quality study available, which is a randomized controlled trial published in 2022 1, isotretinoin combined with topical clobetasol 0.05% and tacrolimus 0.1% was found to be more effective than monotherapy with topical treatments in improving FFA severity. The study found that facial papules improved after 6 months, and frontotemporal hairline, total scalp margins, and total combined scores also improved more in the isotretinoin group than in the control group. However, it's essential to note that the evidence for using isotretinoin in combination with hydroxychloroquine and 5-alpha reductase inhibitors specifically is limited, and this combination should be approached cautiously, weighing potential benefits against risks including teratogenicity of isotretinoin, retinopathy with hydroxychloroquine, and sexual side effects from 5-alpha reductase inhibitors. Some key points to consider when using isotretinoin for FFA include:
- Isotretinoin dosage: typically prescribed at 10-20mg daily
- Treatment duration: usually extends for at least 6-12 months before assessing efficacy
- Monitoring: regular monitoring for side effects, including lip dryness, telogen effluvium, and malaise
- Baseline tests: liver function tests, lipid profile, complete blood count, and pregnancy testing for women of childbearing potential are essential, with ongoing monitoring throughout treatment. Other studies, such as the one published in 2024 2, found that finasteride and hydroxychloroquine are equally effective, safe, and well-tolerable for treating FFA patients, but these studies did not investigate the use of isotretinoin in combination with hydroxychloroquine and 5-alpha reductase inhibitors. In summary, while the evidence is limited, the most recent and highest quality study suggests that oral isotretinoin combined with topical treatments may be effective in improving FFA severity, and this combination may be considered for treatment-resistant FFA cases, with careful monitoring and consideration of potential risks.