451 Spironolactone for treatment of concomitant female pattern hair loss in scarring alopecia patients

Abstract

Background: Lichen planopilaris (LPP), frontal fibrosing alopecia (FFA), and central centrifugal cicatricial alopecia (CCCA) are primary scarring alopecias that occur most commonly in adult females. Female pattern hair loss (FPHL), a non-scarring alopecia, is the most common form of alopecia in females. Due to overlapping patient populations, concomitant FPHL would be expected in many scarring alopecia patients. Prior studies have demonstrated the efficacy of spironolactone in FPHL. Herein, we evaluated the efficacy and safety of spironolactone in females with scarring alopecia and FPHL. Methods: We performed a retrospective review of female LPP/FFA/CCCA patients presenting to a specialized hair loss clinic in 2018 who were treated with oral spironolactone for patterned hair loss. Results: We identified 18 females with scarring alopecia and patterned hair loss who were treated with oral spironolactone. 66.7% had LPP, 16.7% FFA, 16.7% LPP/FFA, and 11.1% CCCA. 72.2% were diagnosed with concomitant FPHL. Mean age at spironolactone start was 57.6 years (range 21.6-76.3). All patients were simultaneously treating scarring alopecia with other therapies. Spironolactone was started at 100mg (56%), 50mg (11%), or 25mg (33%) daily. 83% of patients maintained or increased dose without issue. 2 patients reported side effects including hyperkalemia and leg cramping. 5.6% decreased dose and 11.1% discontinued due to side effect or personal preference. 11 patients used spironolactone for at least 6 months, with an average of 23.3 months. All patients with at least 6 months of spironolactone use maintained or improved Sinclair score (SS) with an average improvement of 0.4. SS improved by 0.16 and 0.7 in patients with initial SS of 1.5-2.0 and 2.0-2.5 respectively. Conclusion: Our preliminary study demonstrates the safety and efficacy of spironolactone in female scarring alopecia patients with concomitant pattern hair loss.