Primary Cicatricial Alopecia: Treatment Approaches and Classification

The document from December 2016 reviews the treatment approaches for primary cicatricial alopecia (PCA), a group of disorders causing permanent hair loss due to follicle destruction and scarring. It highlights the classification of PCAs by inflammatory infiltrate and focuses on lymphocytic PCAs such as chronic cutaneous lupus erythematosus (CCLE), lichen planopilaris (LPP), frontal fibrosing alopecia (FFA), and Graham-Little syndrome. Diagnosis is often delayed, leading to significant hair loss before it becomes noticeable. Treatments aim to halt hair loss and manage symptoms, with regrowth not typically expected. Treatments include corticosteroids, intralesional triamcinolone acetonide, and minoxidil for remaining follicles. Hair transplantation is considered risky. For CCLE, antimalarials, oral corticosteroids, and ITA injections are effective, while acitretin and hydroxychloroquine have similar efficacy, though acitretin has more adverse events. Other treatments for CCLE and LPP include dapsone, thalidomide, methotrexate, azathioprine, cyclosporine, ustekinumab, apremilast, laser therapy, and plasmapheresis. FFA treatments include finasteride, dutasteride, and tetracyclines, while Graham-Little syndrome may be treated with a similar range of therapies. The document notes that partial response to therapy is typical, and spontaneous improvement can occur. It advises against over-the-counter hair loss products due to lack of evidence and states that shampooing frequency does not affect hair loss.