Methotrexate Microinfusion Shows Promise in Treating Frontal Fibrosing Alopecia, reveals research

In the clinical practice wherein both topical and systemic therapies such as methotrexate tablets frequently fail to manage the activity of FFA, this investigation sought to uncover a new delivery method of giving the drug topically into the skin. FFA is one of the forms of scarring alopecia, which primarily involves women, and results in progressive recession of the hairline and loss of eyebrows, usually accompanied by pruritus (itching), desquamation (scaling), erythema (redness), and pain. Standard treatments typically have limited effectiveness, emphasizing the need for urgent development of novel therapeutic strategies.

This prospective, controlled clinical study was performed with 17 volunteers diagnosed with FFA according to both clinical and histological examination. All the patients received three courses of MTX application through MMP® (microinfusion of drugs into the skin method) at 30-day intervals. MTX was applied to only the right side of the alopecia area, and the left side was used as an untreated control. The split-scalp design allowed a direct comparison between treated and untreated areas in the same patient.

Dermoscopic images and clinical measurements were obtained pre- and post-treatment to evaluate changes in scalp status and hairline location. Also, participants' laboratory test findings were followed during the study for safety assessment.

Key Findings

• Study participants: 17 patients with histologically verified FFA

• Treatment frequency: 3 applications of MTX MMP®, at 30-day intervals

• Treatment site: Right half of the alopecia area treated; left half used as control

Improvements:

• Substantial decrease in frontal-glabella and frontal temporoparietal readings in treated fields

• 95% of subjects satisfied or very satisfied with result

• Improvements in symptoms reported for pruritus and desquamation

• No significant alterations in hair loss, local erythema, or LPPAI scores

• Safety: No unusual laboratory test values in any subject

This research concludes that MTX microinfusion with the MMP® method is a safe, tolerable, and symptom-reducing therapy for frontal fibrosing alopecia. These positive findings indicate that LMTX delivery may be a useful addition to the management of FFA, especially in non-responsive patients to standard systemic or topical therapy.

Reference:

Pitlovanciv, T. E. de S., Skare, T. L., Medeiros, K. B., & Fabri, A. B. (2025). Efficacy of methotrexate microinfusion in scalp lesions of patients with frontal fibrosing alopecia: A prospective controlled trial. Skin Appendage Disorders, 11(2), 151–158. https://doi.org/10.1159/000540846