From the Guidelines
Combining isotretinoin and hydroxychloroquine for the treatment of frontal fibrosing alopecia should be done with caution due to potential interactions, particularly ocular toxicity, and requires comprehensive baseline screening and regular monitoring. When considering this combination, it is essential to weigh the potential benefits against the risks, as both medications can cause similar adverse effects. Hydroxychloroquine can cause retinopathy with long-term use, as noted in the 2016 revision of recommendations on screening for chloroquine and hydroxychloroquine retinopathy 1, while isotretinoin may cause dry eyes and decreased night vision. Additionally, both medications can potentially cause elevated liver enzymes and lipid abnormalities, as mentioned in the guidelines of care for the management of acne vulgaris 1. If combination therapy is clinically necessary for refractory FFA, consider using lower doses of both medications when combining them, such as hydroxychloroquine 200mg daily and isotretinoin at 10-20mg daily. The rationale for this combination in FFA relates to hydroxychloroquine's anti-inflammatory properties and isotretinoin's ability to reduce sebaceous gland activity and potentially modulate immune function, addressing different pathophysiologic aspects of this scarring alopecia. Some key points to consider when combining these medications include:
- Comprehensive baseline screening, including complete ophthalmologic examination, liver function tests, and lipid panels
- Regular monitoring throughout treatment to detect potential adverse effects early
- Individualized treatment based on patient factors and response
- Potential for additive ocular toxicity, requiring careful monitoring and dose adjustment as needed. It is crucial to prioritize the patient's safety and adjust the treatment plan accordingly, considering the potential risks and benefits of this combination therapy.
From the Research
Potential Interactions or Complications
There are no research papers to assist in answering the question about the potential interactions or complications of combining isotretinoin (Accutane) and hydroxychloroquine (Plaquenil) for the treatment of frontal fibrosing alopecia.
Available Treatment Options
- Hydroxychloroquine has been shown to be effective in reducing signs and symptoms of frontal fibrosing alopecia after 6 and 12 months of treatment 2
- Finasteride and hydroxychloroquine are equally effective, safe, and well-tolerable for treating frontal fibrosing alopecia patients 3
- Other treatment options such as dutasteride, pimecrolimus, and minoxidil have been evaluated, but there is no consensus or standard treatment regimen for frontal fibrosing alopecia 4, 5, 6
Clinical Characteristics
- Frontal fibrosing alopecia is characterized by the recession of the frontal, temporal, or frontotemporal hairline, and may include eyebrow hair loss, pruritus, facial papules, eyelash loss, body hair involvement, and trichodynia 6, 2
- The clinical pattern is distinct and usually includes eyebrow hair loss, as well as other associated symptoms 6