Treatment of Scarring Alopecia

Injured hairs may respond to aggressive treatment

Scarring Alopecias are a group of hair loss conditions that are generally associated with permanent hair loss. They are also typically associated with inflammation just a few mm under the scalp. This inflammation destroys hair follicle stem cells and impairs the ability of the hair follicle to regenerate.

Since the  hair loss tends to be permanent, I often treat these conditions aggressively in the early stages. Aggressively, refers to a combination of topical, intralesional and oral medications rather than just starting with topical treatments and "seeing what happens." The early and aggressive treatment of scarring alopecias can sometimes lead to regrowth of some follicles that have only been injured by the inflammatory process and not permanently damaged. In the picture, the arrow  points to a hair follicle that has regrown in a patient with lichen planopilaris - 2 months after starting hydroxychloroquine, intralesional triamcinolone acetonide and a topical