National Scarring Alopecia Awareness Month (Day 13, Fact 13): Treatments That Help One Patient with Scarring Alopecia May Not Help Another Patient

A Given Treatment for Scarring Alopecia Helps A Proportion of Patients

There are many treatments that have been studied for the various types of scarring alopecia. One generally prescribes one or more “first-line” treatments before moving on to second-line or third-line treatments. First-line treatments have an ideal combination of factors in the “SAFE” Principle- safe, affordable, feasible and effective. 

Treatments do not help everyone. We do not prescribe a treatment with the advice “This will work so use it” Rather we prescribe treatment with the advice “This may work. Studies show it has a ________% chance of helping patients with your condition. It has these side effects: ___________. It costs this amount: ______________. Please consider using it if you are comfortable with all the possible side effects and we’ll review again in 3-6 months if you are one of the patients that it helps. The other options you might consider if you are not comfortable with this medication are : _____________ and the side effects and cost of these medications are ___________________.

It is up to the practitioner to fill in the blank spaces above in order to help the patient make proper “informed consent.”

If a treatment has been shown to help in various studies, one must remember that this does not mean it stops the disease completely. Rather the information simply refers to the fact that it helps one of more aspects of the disease. A medication may stop itching and burning or redness and so be deemed in studies to “help” despite the fact that the patient using the particular medication may still proceed to lose more hair. Granted, the rate of loss might be slower.

Therefore, one starts a first-line medication with the hope it will help the patient. The patient is reevaluated by the practitioner in a defined period of time to see if the medication is not only helping to stop redness, shedding, scale, itching, burning and tenderness.... but also hair loss.  One does not rely on “seeing new sprouts of hair” or rely in comments that “I think it’s better” - one relies on objective measures to determine if a treatment is helping. Photos can help accurately determine if hair loss is being stopped or even reversed to some degree.