Primary Cicatricial Alopecias: Clinicopathology of 112 Cases

December 2003 in “ Journal of the American Academy of Dermatology ”

Eileen Tan, Magdalena Martinka, Nigel J. Ball, Jerry Shapiro

primary cicatricial alopecias lymphocytic cicatricial alopecias neutrophilic cicatricial alopecias scalp biopsies corticosteroids antimalarials isotretinoin antibiotics follicular destruction cicatricial alopecia scalp biopsy steroids Accutane

TLDR Accurate diagnosis and aggressive treatment are crucial to prevent permanent hair loss in cicatricial alopecia.

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.

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