Antiandrogenic drugs, a therapeutic option for frontal fibrosing alopecia patients

frontal fibrosing alopecia patients To the Editor:We thank Dr Tziotzios and colleagues for the comments on our article. We want to clarify some points about the potential usefulness of oral antiandrogens (OA) in the treatment of frontal fibrosing alopecia (FFA): FFA patients without androgenetic alopecia (AGA) treated with OA may also benefit from this treatment. In fact, stabilization of the disease or even better effect was observed in the 10 FFA patients without AGA treated solely with OA in our study. Tziotzios and colleagues raise awareness about the adverse effects of OA, especially the risk of developing breast cancer. Nevertheless, recent studies have attested to the safety of these drugs. There is increasing evidence that FFA is not a pure immune-mediated disease and that an as yet unknown hormonal mechanism might play a role: B More than 95% of cases of FFA occur in females. B The majority of women diagnosed with FFA develop the disease in the perimenopausal period. B There is an increased incidence of early menopause and gynecologic surgeries in FFA patients. B OA is useful to stabilize the disease in some patients, even in monotherapy. In addition, our research group is now performing an in-depth molecular analysis of signaling pathways potentially altered in the skin of FFA patients. Indeed, our preliminary results suggest that the expression and/or function of certain gene products involved in specific sex-hormone signaling are constitutively impaired in these patients.