Finasteride Versus Hydroxychloroquine for FFA

Frontal fibrosing alopecia (FFA) can leave permanent hair loss along the front and sides of the scalp. A dermatologist may aim to stop further loss and ease itching or pain. The American Academy of Dermatology¹ calls preventing further loss “stabilization.” That goal deserves a separate conversation from how much hair might grow back.¹

What was compared?

A randomized study enrolled 34 women, ages 30–70, for six months. They received finasteride 2.5 mg daily or hydroxychloroquine 400 mg daily. Both groups also used scalp pimecrolimus, mometasone and 5% minoxidil. This compared combinations; neither pill was tested alone.²

Did one treatment restore the hairline?

Average FFA severity scores fell from 8.84 to 6.67 with finasteride and 10.92 to 8.14 with hydroxychloroquine. Lower scores indicate less severe disease. The groups did not differ significantly overall. Front and temple recession measurements did not improve significantly within either group.²

Thirty-two women completed this open-label study. This small study cannot establish equal effectiveness or long-term safety.²

What changes the prescribing conversation?

Finasteride use for FFA in women is outside its US approved indication. Its label contraindicates use in women who are or may become pregnant because of potential harm to a male fetus. They should also avoid handling crushed or broken tablets. Tell the prescriber about pregnancy plans before discussing this option.³

Hydroxychloroquine requires a different review. Its US label warns of potentially irreversible retinal damage and recommends a baseline eye examination within the first year. Dose relative to body weight, kidney impairment, tamoxifen use and existing macular disease affect retinal risk. Ask which eye tests and follow-up schedule fit your circumstances. Heart conditions and medicines that prolong the QT interval, a measure of electrical recovery between heartbeats, also require review.⁴

What should you bring to follow-up?

Ask the dermatologist to distinguish a change in scalp inflammation, symptoms and hairline position. FFA treatment commonly combines therapies, and a plan should reflect your examination and health history. Our guide to FFA observations can help describe the changes that prompted the visit.¹

Hair, Everywhere includes a Hair Log for dated photographs and treatment start dates. Bring that record to appointments; its section specifically says scarring warning signs should go straight to a dermatologist. See the book.