Cicatricial Alopecias: Diagnosis and Treatment Complexities

July 2012 in “ Springer eBooks ”

Yolanda M. Lenzy, Amy J. McMichael

TLDR The document concludes that more research is needed to better understand and treat scarring hair loss conditions.

The document from 2012 addresses the complexity of diagnosing and treating cicatricial alopecias, a group of disorders characterized by scarring hair loss. It outlines the North American Hair Research Society's classification of primary cicatricial alopecias and discusses the clinical features and treatment options for specific types such as central centrifugal cicatricial alopecia (CCCA) and lichen planopilaris (LPP). Treatments range from topical and intralesional steroids to systemic agents like hydroxychloroquine, methotrexate, cyclosporine, and mycophenolate mofetil, with minoxidil suggested as an adjuvant therapy. Hair transplantation is considered for stable disease. The document also addresses the treatment of related conditions such as chronic cutaneous lupus erythematosus (DLE), dissecting cellulitis of the scalp (DCS), and folliculitis decalvans (FD), recommending a therapeutic ladder approach. It concludes with a call for more research to improve the understanding and management of these challenging conditions.

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Research cited in this study

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Scalp biopsies are crucial for diagnosing hair loss conditions like Diffuse Unpatterned Alopecia (DUPA) and retrograde hair loss, as treatments like finasteride and dutasteride may not be effective if other conditions are present. Combining PPAR-GAMMA agonists with retinoids could improve treatments for conditions like Lichen Planopilaris.

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Lichen Planopilaris (LPP), a form of permanent hair loss, which can be mistaken for seborrheic dermatitis and is characterized by scalp itching, burning, redness, and dandruff. Treatment options discussed include steroidal creams, finasteride, minoxidil, and RU58841.

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