Evaluation of microneedling in the treatment of frontal fibrosing alopecia

Background: Frontal fibrosing alopecia (FFA), an increasingly diagnosed cicatricial alopecia, has many unapproved therapeutic options. Microneedling is a minimally invasive procedure with promising results in the treatment of alopecia. Objective: To evaluate efficacy and safety of microneedling as an adjuvant therapy in frontal fibrosing alopecia. Methods: An open uncontrolled study of 4 monthly microneedling sessions as an adjunct therapy was conducted for patients with FFA. Measurements of the frontotemporal recess, photographic and trichoscopic evaluations, Dermatology Life Quality Index (DLQI) and Lichen Plano Pilaris Activity Index (LPPAI) were evaluated 12 weeks prior to the first session, at every session and 4 weeks and 12 weeks after the last session. Results: Seventeen adult women completed the study. Frontotemporal recession measurements remained stable throughout the study. There was a reduction in DLQI (4.4 versus 1.3; p = 0.004) and LPPAI (1.5 versus 1.1; p = 0.09) between baseline and last visit (12 weeks after last session). There were no severe adverse events or evidence of Koebner phenomenon. Study limitations: Our study has a small number of patients and lacks a control group. Conclusions: There was improvement in quality of life and reduction of inflammatory activity parameters twelve weeks after treatment, while frontotemporal recess remained stable throughout study.