Management of primary cicatricial alopecias: options for treatment

Abstract

Primary cicatricial alopecias (PCAs) are a poorly understood group of disorders that result in permanent hair loss. Clinically, they are characterized not only by permanent loss of hair shafts but also of visible follicular ostia along with other visible changes in skin surface morphology, while their histopathological hallmark usually (although not always) is the replacement of follicular structures with scar-like fibrous tissue. As hair follicle neogenesis in adult human scalp skin is not yet a readily available treatment option for patients with cicatricial alopecias, the aim of treatment, currently, remains to reduce symptoms and to slow or stop PCA progression, namely the scarring process. Early treatment is the key to minimizing the extent of permanent alopecia. However, inconsistent terminology, poorly defined clinical end-points and a lack of good quality clinical trials have long made management of these conditions very challenging. As one important step towards improving the management of this under-investigated and under-serviced group of dermatoses, the current review presents evidence-based guidance for treatment, with identification of the strength of evidence, and a brief overview of clinical features of each condition. Wherever only insufficient evidence-based advice on PCA management can be given at present, this is indicated so as to highlight important gaps in our clinical knowledge that call for concerted efforts to close these in the near future.

Primary Lymphocytic Cicatricial Alopecia: A Retrospective Analysis of 36 Patients

“…Its appearance was thought to look like "footprint in the snow." The patches are usually atrophic and have no inflammation (14). In our study, atrophic alopecic patches were seen in all PB patients, and the patients came to our clinic with the complaint of hair loss.…”

“…Potent topical corticosteroids or ICSI applications are the first-choice treatment options for LPP (14,15). Oral corticosteroids, oral cyclosporine, and oral tetracycline are the second-line treatment options that can be used in patients who do not benefit from these treatments (14).…”

“…Systemic corticosteroid therapy was successfully used in 5 (19.2%) of 26 LPP patients (first choice in 4 patients, second choice in 1 patient) in this study. Oral isotretinoin, oral antimalarials, thalidomide, griseofulvin, mycophenolate mofetil, and excimer laser are the third most common agents in LPP treatment (14).…”

“…Oral corticosteroids, oral cyclosporine, and oral tetracycline are the second-line treatment options that can be used in patients who do not benefit from these treatments (14). In our study, ICSI application was used in 57.7% (n=15) of the LPP patients, hydroxychloroquine in 15.4% (n=4), and systemic corticosteroids in 15.4% (n=4) of the patients, and each of the remaining 3 patients received topical corticosteroid treatment, the combination of topical corticosteroid and hydroxychloroquine treatment, and the combination treatment of topical corticosteroids and phototherapy, respectively.…”

Hair Transplantation in the Cicatricial Alopecias

“…Neutrophil-predominant subgroup of primer cicatricial alopecias is treated with antimicrobials or dapsone. Surgical treatment of stable cicatricial alopecia includes hair transplantations, primer excision of affected area, flap surgery, or scar reduction with tissue expansion [5,6]. Follicular Unit Extraction method is the process that nearly 1 mm diameter micrografts taken from the donor area are placed into predrilled holes in the recipient region.…”