Primary Cicatricial Alopecias: Clinicopathology of 112 Cases

The study reviewed 112 cases of primary cicatricial alopecias over 5 years at the University of British Columbia Hair Clinic, representing 3.2% of consultations. It found a 4:1 ratio of lymphocytic to neutrophilic cicatricial alopecias, with lymphocytic types more common in middle-aged women and neutrophilic types in middle-aged men. Accurate diagnosis required careful clinicopathologic evaluation, often necessitating multiple scalp biopsies due to the variable clinical course. The study emphasized the need for aggressive, multi-modal treatment to prevent irreversible follicular destruction, suggesting cicatricial alopecia should be treated as a trichologic emergency. Treatment options included corticosteroids, antimalarials, and isotretinoin for lymphocytic types, and antibiotics, corticosteroids, and isotretinoin for neutrophilic types.