Management of Primary Cicatricial Alopecias: Options for Treatment

M.J. Harries; R.D. Sinclair; S. MacDonald-Hull; D.A. Whiting; C.E.M. Griffiths; R. Paus


The British Journal of Dermatology. 2008;159(1):1-22. 

In This Article


PCAs are a poorly understood group of disorders that result in permanent alopecia. The aim of treatment is to reduce symptoms and slow or stop progression of the cosmetically disfiguring scarring process. Early treatment is the key to preventing permanent hair loss. Inconsistent terminology in the literature, poorly defined clinical end-points and a lack of good quality clinical trials make management of these conditions very difficult, and at times almost impossible.

In order to improve significantly the – generally very unsatisfactory – EBM database for therapeutic options in cicatricial alopecia, and to allow more objective, in-depth critical assessment of currently advocated cicatricial alopecia management options, it remains a crucial challenge that much larger cohort, multicentre, prospective studies with a double-blinded design and optimally chosen controls, documentation and classification standards, as well as quantitative methodology, are performed. Only when such studies have become available shall one be able to provide more stringent treatment recommendations than are currently possible. All physicians who see and manage patients with cicatricial alopecia, therefore, are strongly encouraged to enrol their patients in professionally designed multicentre trials.

With increasing support for PCA research and education by specialized organizations [such as the Cicatricial Alopecia Research Foundation (] and the introduction of the NAHRS classification of PCAs,[11] it is hoped that standardized reference, evaluation and management tools for PCA will facilitate collaboration between clinicians and researchers and will favour evidence-based over experience-based PCA management. Eventually, this should result in better understanding and, hopefully, new treatments for these hitherto regrettably under-investigated conditions.

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