Response to Bhoyrul B., 'The Treatment of Primary Cicatricial Alopecia Is Challenging'

The response to Dr. Bhoyrul's commentary on the treatment of primary cicatricial alopecia (PCA) acknowledges the lack of randomized controlled trials, with current evidence largely based on case reports and expert opinion. The authors highlight their clinical experience with over 1,000 PCA patients, noting gabapentin's efficacy in reducing scalp pruritus. They agree with Bhoyrul on the documented efficacy of dutasteride for frontal fibrosing alopecia and caution the use of pioglitazone due to potential adverse effects. Phototherapy is contraindicated for photosensitive conditions like discoid lupus erythematosus. The authors emphasize the need for scalp biopsies before treatment and correct a dosage error for rifampin and clindamycin in treating folliculitis decalvans. They call for more robust clinical trials to establish comprehensive treatment guidelines for PCA.