Dr Pablo Fernandez-Crehuet, you recently published Trichoscopic features of frontal fibrosing alopecia. Can you tell us in a simple manner, and 1-2 sentences, what is the take away would be for an average person with hair thinning?

Dermatologists make a complete clinical study of the hair. We study his/her hair distribution, density, diversity in hair diameter, peripilar signs and scalp alterations and blood analysis in order to discard any anomalies in sexual hormones, hemogram, ferritine, zinc, folic acid and b12 vitamin. Depending on theses parameters, we indicate the most appropriate treatment.

How often do you do scalp biopsies on male pattern baldness patients?

Not very often. Only cases in which we suspect another type of alopecia different from androgenetic alopecia are subsidiary to scalp biopsy i.e: areata, discoid lupus, frontal fibrosing.

What general advice do you give to the typical male or female with androgenetic alopecia?

Firstly we strong recommend visiting a dermatologist in order to get a correct diagnosis. If, finally, androgenetic alopecia is confirmed the specialist will explain all the well-demonstrated therapies for this kind of alopecia. Minoxidil and finasteride actually are the best options for grades 1-3 and follicular transplant for the severe alopecia. Other therapies such as LEDs, Platelet-rich plasma are being studied

What general advice do you give to the typical male or female with frontal fibrosing alopecia?

Firstly visit a dermatologist. Other specialist are not used in identifying this type of inflammatory alopecia. Once we make the diagnosis, the treatment is based in topical or oral corticosteroids, hydroxychloroquine, finasteride, and topical minoxidil.

Do you ask all your hair thinning patients to try minoxidil, even if it’s not androgenetic?

Yes, I do. Although frontal fibrosing alopecia is an inflammatory process, most of the patients presented androgenetic alopecia as well, so this kind of treatment helped to increase hair density in this patients.

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