What can I do About the Blue Veins I see in FFA?

Frontal Fibrosing Alopecia and Blue Veins

I’ve selected this question below for this week’s question of the week. It allows us to the review the concept of scalp atrophy in patents with frontal fibrosing alopecia and the role of 5 alpha reductase inhibitors and retinoids.

Question

Dear Dr Donovan,

I would be very grateful for your advice. I have been diagnosed with frontal fibrosing alopecia and was prescribed Dermovate lotion which I have been taking for almost 6 months. I noticed that veins on the temples and forehead have now become very prominent. I have now discontinued Dermovate.

But is there a way one can reverse the formation of these thick blue veins ? I have read that tretinoin cream thickens the skin: would it be advisable to use this? [I have taken Retin-A before and it did not irritate my skin]. Perhaps there is another medication you might suggest that could reverse the thinning of the skin in these areas? I have also taken Minoxidil but even after 7 months of using it I have not seen any improvement.

Would you advise that I discontinue it? Many thanks for your help!

Answer

Thanks for the question. The blue veins are showing up because of thinning of the skin or what is known as atrophy. The FFA disease itself can cause atrophy and so can the use of strong topical steroids. A dermatologist can assess which might be the reason in your case once they review your full story and examine the area. Certainly, Dermovate can worsen thinning and increase veins in some women with FFA.

The best way to stop atrophy and potentially reverse it is to stop the disease itself. Minoxidil its not going to do that.

Finasteride and dutasteride are among the most effective treatments we know of to help reverse skin atrophy in FFA. At least for now. They are more effective in this regard orally than topically but not everyone is a candidate for these medications so that is a discussion you would need to have with your dermatologist. The “oral retinoids” like isotretinoin and acitretin may help some women with atrophy as well. The topical versions like you describe are likely less effective than the oral formulations but that does not mean they are without benefit.

Thanks again for the question. Be sure to keep close follow up with your dermatologist. Worsening veins can sometimes be a sign of worsening diseases and the need to consider more aggressive treatment in order to stop the disease.