Update on Treating Scarring Alopecia

Over the years we have noticed an increase in the number of patients with Scarring Alopecia.  While part of the reason for this is that the medical community is becoming better at identifying, we also do believe that the incidence of scarring alopecia is increasing.  There is some evidence that certain harsh hair care practices may contribute to some forms of Scarring Alopecia, such as the use of chemical relaxers from a very young age. This type of hair loss is much more common in women than men, with some studies reporting as high as a 4:1 ratio of women to men. There is some evidence to suggest an autoimmune cause, and there may be a genetic component as well, but more research definitely needs to be done.

There are several types of Scarring Alopecia, with the most common being Central Centrifugal Cicatricial Alopecia (CCCA), Lichen PlanoPilaris (LPP), and Frontal Fibrosing Alopecia (FFA).  As Scarring Alopecia can be permanent, our goal with any patient that we believe may have a Scarring Alopecia is to quickly confirm the diagnosis and aggressively start treatment.  About one year ago we significantly adjusted our treatment approach for Scarring Alopecia to include oral doxycycline and topical clobetasol.  We are excited to say that this approach has proven to be quite beneficial to our patients.  For a long time the goal of treatment with Scarring Alopecia was to stop the further progression of hair loss as the loss was often permanent.  However, we have many patients on our new regiment that are experiencing some regrowth.  While it is impossible to know if regrowth will occur, we are very excited to see how often our Scarring Alopecia patients are seeing positive results.

If you have been diagnosed with a Scarring Alopecia we highly recommend seeing a medical practitioner that is experienced with treating this type of hair loss.

Posted by Your Medi Tresse Team

 The content contained herein is for education only and should not be considered medical advice.  Medical advice may only be given through a one-on-one, private consultation with an appropriate licensed medical provider.

Platelet Rich Plasma Therapy and Scarring Alopecia

Over the past five years there has been a greater acceptance in the use of Platelet Rich Plasma (PRP) Therapy for hair loss as we have seen many successful studies.  However, most of the research and studies focused on patients with androgenic alopecia, which is tied to genetics and is the most common cause of hair loss.  As the benefits of PRP Therapy are being more understood, we are seeing its uses expanded, including in the treatment of Alopecia Areata and some Scarring Alopcias.  There was an exciting case study shared in the July 2019 journal of Dermatologic Surgery on the successful treatment of two patients with scarring alopecia using PRP Therapy.

While less common than androgenic alopecia, according to the Canadian Medical Association Journal, patients with scarring alopecia make up 7% of patients experiencing hair loss.  While the cause of scarring alopecia is not entirely known, scarring alopecia causes inflammation around that hair follicle that eventually leads to the permanent destruction of the follicle.  There are various types of scarring alopecias, with the most common being Lichen Planopilaris (LPP), Frontal Fibrosing (Alopecia), and Cicatricial Alopecia (CCCA).  For each type of scarring alopecia treatment can vary slightly, with the exception of topical or injected steroids, which are typically the first recommended treatment for all types of scarring alopecia.

So is PRP Therapy a treatment option for scarring alopecia?  It is important to remember that the case study in the July 2019 journal of Dermatologic Surgery included only two patients, but below describes the patients and their outcomes:

Patient 1 Patient 2
Age 53 70
Gender Female Female
Race African – American Caucasian
Hair Loss History Decreased density along the scalp vertex since her mid-40s. Several years of gradual hair loss diffusely across the scalp. Diminished hair density along frontal hairline and scalp vertex.
Diagnosis Cicatricial Alopecia (CCCA) with mild component of Androgenic Alopecia Lichen Planopilaris (LPP)
Other Treatments Spironolactone, steroids (topical and injections), topical minoxidil.  All were considered ineffective and were stopped prior to PRP Therapy. Steroid (topical and injections), hydroxychloroquine 400mg daily. Did not lead to improvement, but continued topical and hydroxychloroquine during PRP Treatment.
Outcome Normal follicular density was noted along temporal hair line and greater than 50% improvement in hair density along scalp vertex. Normal density was noted diffusely across scalp and hairline.

This case study shows that there is a place for the use of PRP Therapy in the treatment of some scarring alopecias.  At Medi Tresse we have had success in utilizing PRP as a treatment for some patients with scarring alopecia, especially when there is a component of androgenic alopecia as well.  While more research needs to continue, this case study is great news for patients with scarring that have not had success with traditional treatments, like steroids, as it gives them another potential option.  If you think you could benefit from Platelet Rich Plasma (PRP) Therapy contact our office to schedule a free consultation.

Scarring Alopecia

When we first opened Medi Tresse and started seeing women experiencing hair loss, virtually all the patients who came in for evaluation were experiencing symptoms of Androgenic Alopecia, which is the most common type of hair loss in women. The hair loss occurred slowly over many years, sometimes decades, and many of them had family histories consistent with the genetic basis for Androgenic Alopecia. Research on the treatment for this type of hair loss is extensive and fortunately the treatment is usually very successful. These treatments include minoxidil (82M), LLLT (low level laser therapy) and PRP (platelet rich plasma), as well as supplements like Nutrafol and Viviscal. Sometimes hair transplant is an option as well.

Recently we are seeing increasing numbers of women with Scarring Alopecia, which is an inflammatory cause of hair loss, and a much more challenging problem to treat. At a recent international conference on hair loss I heard the world’s experts debate the potential causes, but at this point we really don’t understand why this is happening more frequently. There is some evidence that certain harsh hair care practices may contribute to some forms of Scarring Alopecia, particularly in African American women that use chemical relaxers from a very young age. This type of hair loss is much more common in women than men, with some studies reporting as high as a 4:1 ratio of women to men. There is some evidence to suggest an autoimmune cause, and there may be a genetic component as well, but more research definitely needs to be done.

Scarring Alopecia results in permanent damage of the hair follicle if treatment isn’t started immediately. Unfortunately, in the early stages, it often looks very similar to Androgenic Alopecia and treatment may be delayed. However, the major difference is the rate of hair loss, which is much faster with Scarring Alopecia.

There are several types of Scarring Alopecia: Central Centrifugal Cicatricial Alopecia (CCCA), Lichen PlanoPilaris (LPP), and Frontal Fibrosing Alopecia (FFA). If a woman presents with a more rapid rate of hair loss, as well as evidence of inflammation around the base of the hair follicle on examination, then we become concerned with the possibility of Scarring Alopecia. The pattern of hair loss may be patchy, or as in FFA present as a band of loss along the frontal hairline with loss of eyebrows as well. A biopsy is essential to confirm the diagnosis.

Regardless of which type of Scarring Alopecia exists, the initial treatment is usually steroids, topical or injected. Strong consideration should be given to oral medication, which may include doxycycline, hydroxychloroquine, and dutasteride. Newer treatments like laser therapy and PRP have not been studied at length, and should be considered only after standard treatments have failed. We have had some success utilizing PRP in CCCA, especially in women with some underlying Androgenic Alopecia as well.

Patients with scarring alopecia need to be followed carefully and treated aggressively. At Medi Tresse we are fully capable to treat all types of hair loss in women, and early diagnosis and treatment is essential, especially in Scarring Alopecia in order to prevent permanent loss.

Posted by Dr. Mary Wendel