Primary cicatricial alopecia, often called cicatricial alopecia, is a group of disorders characterized by a final common pathway of replacement of hair follicle structures by fibrous tissue. Jerry Shapiro, MD, FAAD, Professor and Director of Hair and Scalp Disorders, Ronald O. Perelman Department of Dermatology, NYU Langone Health, New York, at the presentation “Recent Advances in Hair Restoration” at Maui Derm Hawaii 2023 , New York, detailed treatment options for this disease.
Shapiro highlighted the challenges in treating this disease due to lack of data. There are no placebo-controlled, double-blind, randomized studies of treatment. This is partly due to the difficulty in measuring the extent of the disease and the impact of minimally effective treatments.
However, there are some clinical indications that the patient requires detailed treatment planning.
- Hyperkeratosis
- Erythema
- pull test positive
- Symptomatic (itching, burning, pain)
Shapiro utilizes different treatment regimens depending on the extent of hair loss. If less than 10% of her scalp is affected, I recommend starting with a strong topical steroid. If there is no sign of improvement, options include solutions of hydroxychloroquine, isotretinoin, or tacrolimus 0.3% BID, corticosteroids BID, and 5% minoxidil solution BID.
If a patient’s hair loss is greater than 10%, treatment considerations include hydroxychloroquine 200 mg BID, superpotent topical steroids, IL-TAC, and prednisone.
One form of scarring alopecia Shapiro discussed is frontal fibrosing alopecia (FFA), first described over 30 years ago. “This condition is increasing at epidemic rates,” he said. This particular variant primarily affects postmenopausal women, although about 20% of cases are now found in men. Researchers have not found a reason why this form of alopecia is spreading so quickly, but it could be due to several factors, including genetics, hormones and previous cosmetic surgery to the face and scalp. I have.
The increase in FFA has led medical professionals and researchers to question the possibility of environmental factors. Shapiro says that while there are many studies showing a positive correlation between face sunscreen use and FFA, there is insufficient evidence to establish a direct relationship between the two.
“For safety, we tell our patients to avoid using oxybenzone and avobenzone in sunscreens and use more physical ones such as zinc oxide and titanium dioxide. Use a mineral-based sunscreen on your face.” I’m telling you to use it,” Shapiro said.
Shapiro touched on the increasing use of lasers to aid in hair growth. Potentially, it may become a more commonly used alternative or adjunctive treatment to conventional treatments.
reference
1. Shapiro, J. Management of alopecia in 2023; presented at Maui Derm Hawaii 2023. January 23-27, 2023. Hawaii, Maui.
