LS6 MANAGEMENT OF SCARRING ALOPECIAS

Wolff, H.; Department of Dermatology, Ludwig-Maximilians-University, Munich, Germany

Scarring alopecia is a leading symptom in the following diagnoses: Chronic discoid lupus erythematodes (CDLE) of the scalp, lichen planopilaris (LPP), postmenopausal frontal fibrosing alopecia (PFFA), folliculitis decalvans (FD) and dissecting folliculitis (DF).

The first step in the management of a scarring alopecia is the correct diagnosis. Often a scalp biopsy is necessary. If CDLE is a potential diagnosis, the biopsy should provide a sample for direct immunofluorescence.

Therapies of T-cell mediated alopecias such as CDLE and LPP are directed towards reduction of autoimmune and inflammatory phenomena. This can be tried with class IV maximum strength topical corticosteroids  applied as solution or as creme under occlusive dressing. Systemic corticosteroids are not recommended for long term therapy. In CDLE, antimalarials such as hydroxychroloquine sometimes can stop the disease for the time they  are being used. In addition, protection from sunlight is essential. In LPP, acitretin may be helpful. PFFA is thought to be a variant of LPP. Therefore, the progression of the alopecia might respond to topical class IV coricosteroids or acitretin.

In FD, staphylococcal infection is essential. Therefore, a 10-week antibiotic combination therapy consisting of rifampin (300-0-300 mg/day) and clindamycin (300-0-300 mg/day) according to Powell et al. (Br J Dermatol 140:328-333, 1999) is recommeded. In DF, surgical debridement in combination with isotretinoin has been helpful.

Therapeutic efficacy is difficult to measure due to the slow natural course of these diseases. A successful therapy is defined as stabilization of the disease. To monitor the slow course of these diseases, we take standardized scalp photographs every six months.