Cicatricial alopecia represents a group of disorders sharing a final pathway of destruction followed by replacement with fibrous tissue of the hair follicle unit. Cicatricial alopecia is classified into two categories, namely primary cicatricial alopecia, in which the hair follicle is the sole target of a progressive inflammatory process in a group of diverse skin or systemic diseases, and secondary cicatricial alopecia, referring to the hair follicle destruction as a result of a nonspecific disruption of the dermis. Permanent hair loss may also occur in the late phases of some nonscarring alopecias that are called “biphasic alopecias.” Based on the pathological characteristics, the lesions of primary cicatricial alopecia are divided into lymphocyte-predominant subgroup, neutrophil-predominant subgroup, or mixed subgroup. In principle, the primary goal of the treatment aims to attenuate the progression of the inflammatory and the scarring processes at the earliest phase of the disease. In clinical practice, the lymphocyte-predominant lesions are treated with immunosuppressive agents, whereas the neutrophil-predominant lesions are treated with antimicrobials or dapsone. As the efficacy of medication treatment against the cicatricial alopecia varies significantly, autologous hair transplantation is recommended to patients who have a relatively stable primary or a secondary cicatricial alopecia.
Part of the book: Alopecia