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

Therapeutic Principles

Spontaneous hair regrowth in PCA rarely ever occurs and the much-anticipated induction of de novo neogenesis of hair follicles in adult human skin[17] is not yet a viable option in PCA management.[12] Therefore, the principle aim of treatment is to reduce symptoms and, most importantly, to slow or stop progression of the scarring process. To achieve this, as a general rule, many practitioners experienced in alopecia management treat the lymphocyte-predominant subgroup with immunosuppression and the neutrophil-predominant subgroup with antimicrobials or dapsone.[2]

Patients with completely stable, or 'burned-out' scarring (i.e. without residual inflammatory activity), may profit from scalp reduction surgery so as to remove or reduce the cosmetically and psychologically disturbing scar area, possibly complemented by hair transplantation.[18] In the future, theoretically, hair follicle neogenesis from autologous adult hair follicle cell populations may become an interesting alternative therapeutic option for this subgroup of patients with long-standing and stable cicatricial alopecia without signs of active disease.[12]


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