3 - Diagnosis and treatment of scarring alopecia

Abstract

Scarring or cicatricial alopecia is a diverse class of conditions characterized by inflammation and destruction of the pilosebaceous unit. Scarring alopecia may be primary (e.g., lichen planopilaris, frontal fibrosing alopecia, and central centrifugal cicatricial alopecia) or secondary (e.g., due to radiation, burns, or trauma). In most cases, there is permanent hair loss due to replacement of subcutaneous tissue with fibrous tracts. As a result, scarring alopecia can be disfiguring and cause significant distress in affected patients. Unlike non-scarring alopecia where the follicular unit is preserved and treatment is centered on hair regrowth, treatment for scarring alopecia is largely aimed at reducing inflammation and preventing disease progression. Topical and intralesional corticosteroids are the preferred first-line treatment options for primary scarring alopecia. Other treatment options include surgical hair transplantation, platelet-rich plasma, low-level light therapy, and systemic medications such as hydroxychloroquine.