Control of LPPAI and Photographic Stability in Frontal Fibrosing Alopecia with Methotrexate: An Open-Label Study of 10 Cases

Introduction: Frontal fibrosing alopecia (FFA) is a clinical variant of lichen planopilaris (LPP). There is no established treatment for FFA. It is known that methotrexate (MTX) is effective in treating LPP. The aim of this open label study was to prospectively evaluate the use of MTX in a group of FFA patients. Methods: Patients with scalp biopsy confirming FFA with clinical signs of inflammation and no treatment change in the past 6 months were invited. MTX 15 mg once a week was used during 6 months. The Lichen planopilaris Activity Index (LPPAI) was evaluated at the beginning of treatment and after three and 6 months. Standardized photographs before and after treatment were analyzed to assess disease progression. Results: Twelve patients were included but two dropped out during the study. After 6 months of MTX, LPPAI decreased in nine of the ten participants (2.80 ± 2.07 vs. 1.17 ± 1.12). Clinical pictures showed no progression of hair loss in 7 patients. Conclusion: Our results showed MTX decreases LPPAI in 90% treated patients and stops hair loss progression in 70% of patients after 6 months.