Cicatricial Alopecia Diagnosis and Treatment Approaches

Cicatricial alopecia encompasses a group of disorders characterised by permanent hair loss and follicular destruction due to inflammatory or fibrotic processes. Patients typically present with patchy or diffuse areas of scarring, often accompanied by itching, burning or tenderness. Diagnosis relies on a combination of detailed clinical history, scalp examination, trichoscopy and scalp biopsy to distinguish subtypes such as lichen planopilaris, frontal fibrosing alopecia, discoid lupus erythematosus and central centrifugal cicatricial alopecia. Trichoscopic patterns—perifollicular erythema, scaling and absence of follicular openings—guide biopsy site selection, while histopathology reveals lymphocytic or neutrophilic infiltrates, fibrosis and sebaceous gland loss. Management aims to halt progression and preserve remaining follicles. First‐line therapies include high‐potency topical or intralesional corticosteroids, systemic antimalarials, tetracyclines and immunosuppressants. Hormonal modulators such as 5-alpha reductase inhibitors have shown efficacy in frontal fibrosing alopecia. Emerging strategies target key molecular pathways: Janus kinase inhibitors, peroxisome proliferator-activated receptor agonists and biologics directed at immune mediators. Adjunctive measures include low-level light therapy, platelet-rich plasma and meticulous hair care. Despite advances, treatment remains challenging and often requires a personalised, multidisciplinary approach to optimise outcomes and quality of life.

Research from Nature Portfolio

Recent studies have elucidated the genetic and immunological underpinnings of scarring alopecia. A comprehensive genome-wide association analysis identified four susceptibility loci for frontal fibrosing alopecia, including a strong signal at HLA-B*07:02 and variants in a xenobiotic-processing enzyme gene. Transcriptomic profiling of affected scalp tissue revealed enrichment of innate and adaptive immune pathways, framing these conditions as genetically predisposed immuno-inflammatory disorders. Such insights have paved the way for precision diagnostics and the pursuit of molecularly targeted therapies that may intercept early immune activation and prevent irreversible follicular loss.

Cicatricial Alopecia Diagnosis and Treatment Approaches publication trend

The graph below shows the total number of articles in cicatricial alopecia diagnosis and treatment approaches across all publications each year (not limited to Nature Index journals).

Technical terms

Cicatricial alopecia: A group of hair-loss disorders featuring permanent follicular destruction and scarring.

Lichen planopilaris: An inflammatory, lymphocytic cicatricial alopecia variant with perifollicular lichenoid infiltrates.

Frontal fibrosing alopecia: A pattern of scarring hair loss affecting the frontotemporal scalp, often considered a form of lichen planopilaris.

Trichoscopy: Dermatoscopic examination of the scalp and hair to identify characteristic follicular and vascular features.

Janus kinase (JAK): A family of intracellular tyrosine kinases involved in cytokine signalling and immune regulation.

Dysbiosis: Imbalance in the microbial community, which may trigger or perpetuate local inflammation.

References

1. A phase 2a trial of brepocitinib for cicatricial alopecia. Journal of the American Academy of Dermatology (2024).
2. Genome-wide association study in frontal fibrosing alopecia identifies four susceptibility loci including HLA-B*07:02. Nature Communications (2019).
3. Lichen planopilaris and frontal fibrosing alopecia: review and update of diagnostic and therapeutic features. Anais Brasileiros de Dermatologia (2022).
4. Dysbiosis and Enhanced Beta-Defensin Production in Hair Follicles of Patients with Lichen Planopilaris and Frontal Fibrosing Alopecia. Biomedicines (2021).