Continuing medical education
Primary cicatricial alopecia: Lymphocytic primary cicatricial alopecias, including chronic cutaneous lupus erythematosus, lichen planopilaris, frontal fibrosing alopecia, and Graham-Little syndrome

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Both primary and secondary forms of cicatricial alopecia have been described. The hair follicles are the specific target of inflammation in primary cicatricial alopecias. Hair follicles are destroyed randomly with surrounding structures in secondary cicatricial alopecia. This 2-part continuing medical education article will review primary cicatricial alopecias according to the working classification suggested by the North American Hair Research Society. In this classification, the different entities are classified into 3 different groups according to their prominent inflammatory infiltrate (ie, lymphocytic, neutrophilic, and mixed). Part I discusses the following lymphocytic primary cicatricial alopecias: chronic cutaneous lupus erythematosus, lichen planopilaris, frontal fibrosing alopecia, and Graham–Little syndrome.

Section snippets

Introduction and general assessment

Key points

  1. Hair loss may progress subclinically

  2. Diagnosis is often delayed

  3. All hair-bearing areas should be examined

  4. Perifollicular accentuation and isolated hairs are precious clues

  5. Unless there is a true primary infection, cultures are usually negative in patients with primary cicatricial alopecia

  6. Laboratory testing should be performed in accordance with the clinical setting

Primary cicatricial alopecias (PCAs) represent a group of poorly understood conditions in which the destruction of follicular structures

General management of primary cicatricial alopecia

Key points

  1. Evidence supporting therapy is generally poor

  2. The aims of treatment are to stop or reduce hair loss, control the symptoms, and reduce the clinical signs of inflammation.

  3. Regrowth should not be expected

  4. Choice of therapy is guided by the type of inflammatory infiltrate

  5. Duration of therapy is guided by the response and relapse rate

  6. No evidence supports the use of most over the counter products and shampoos

  7. Potent corticosteroids and intralesional triamcinolone acetonide are commonly used in all forms

Chronic cutaneous lupus erythematosus

Key points

  1. Signs and symptoms of systemic lupus erythematosus must be excluded

  2. Chronic cutaneous lupus erythematosus of the scalp usually responds well to therapy

Chronic cutaneous lupus erythematosus (CCLE) is more common in white and African American women.103, 104, 105 It may occur at any age, but predominantly occurs between 20 and 40 years of age.105, 106, 107 Solitary or multiple variable size lesions occur primarily on sun-exposed areas and on the scalp103, 106, 108, 109, 110 (Fig 4). They consist of

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    Dr Bolduc has been a speaker for Johnson and Johnson. Dr Shapiro has been a speaker for, consultant for, or has received honoraria from Merck, Johnson and Johnson, Dr Reddy, and Applied Biology. He is the founder of, has stock options in, and is a shareholder for Replicel. Dr Sperling has no conflicts of interest to declare.

    Date of release: December 2016

    Expiration date: December 2019

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