Low-Dose Oral Minoxidil Improves Hairline and Eyebrow Coverage in Frontal Fibrosing Alopecia: A Prospective Study

INTRODUCTION: Frontal fibrosing alopecia (FFA) is a primary lymphocytic scarring alopecia that commonly presents with frontotemporal hairline recession and eyebrow loss. While most treatments aim to control inflammation and stop disease progression, low-dose oral minoxidil (LDOM) has been proposed to enhance coverage of remaining hairs and improve cosmetic outcomes. METHODS: In this prospective study, adult women with biopsy-proven FFA received oral minoxidil 1 mg/day for 6 months. Standardized photographs and trichoscopy images were obtained at baseline and after treatment and blindly evaluated by two independent experts using a 5-point scale (-2 to +2). Safety was monitored through clinical and laboratory assessments. All patients gave consent for use of their photographs. RESULTS: A total of 11 women were included (mean age 58.2 years); one discontinued treatment due to a transient ischemic attack. Among 10 completers, all showed improvement in at least one area, with increased anterior hairline coverage in nine and eyebrow improvement in four of eight evaluated patients. Mild hypertrichosis occurred in five cases. CONCLUSIONS: LDOM improved anterior hairline and eyebrow coverage in women with FFA and was generally well-tolerated. Protocol Number: HSPM58444422.0.0000.5442.