Scarring alopecia, also known as primary cicatricial alopecia, can result in permanent hair loss from destruction of hair follicles. Hence, early intervention is key to halting disease progression and improving hair density. The purpose of this patient guide, adopted from an article published in 20231, is to improve understanding of the treatment options available for scarring alopecia. It details current evidence-based treatments for different types and varied severities of scarring alopecia.
| Treatments for scarring alopecia | |
| Lymphocytic alopecia | Neutrophilic alopecia |
| e.g. lichen planopilaris (LPP), frontal fibrosing alopecia (FFA), central centrifugal cicatricial alopecia (CCCA) | e.g. folliculitis decalvans, dissecting cellulitis |
| (Treatments aim to reduce inflammation) | (Treatments aim to reduce inflammation and bacterial load) |
| General:
· Avoid allergens in cosmetic and personal care products e.g. re-evaluate use of chemical sunscreens and/or sunscreens containing titanium dioxide with your dermatologist |
Folliculitis decalvans:
· Steroid: Topical/scalp injection · Antibacterial/antibiotic: Benzoyl peroxide wash, oral doxycycline, minocycline, cephalexin, rifampin, clindamycin |
| First-line:
· Topical steroid: Clobetasol, betamethasone, fluocinonide · Steroid scalp injection: Triamcinolone · Topical calcineurin inhibitor: Tacrolimus, pimecrolimus |
|
| Second-line:
· Immunomodulator: Hydroxychloroquine · Anti-inflammatory: Doxycycline, low-dose naltrexone, oral antihistamines, oral gabapentin · Phototherapy: Narrowband UV-B and excimer laser |
Dissecting cellulitis:
· Oral steroid: Prednisone · Isotretinoin: Accutane |
| Severe disease:
· Immunosuppressive: Mycophenolate mofetil, methotrexate, cyclosporine, pioglitazone, topical/oral Janus kinase inhibitor |
Severe disease:
· Immunosuppressive: Dapsone, adalimumab, infliximab |
| For overlapping female/male pattern hair loss:
· Oral low-dose minoxidil – promote hair growth · Oral spironolactone – block androgens that trigger hair loss |
|
| For specific types of scarring alopecia:
· Dutasteride/finasteride – block androgens and stabilize FFA · Compounded topical 10% metformin cream – promote hair growth in CCCA |
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References: