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Cicatricial alopecia

There are a number of disease entities that may give the clinical picture of cicatricial alopecia. The pathological process leads to an irreversible hair loss as a result of the replacement of hair follicles with a scar-like connective tissue. The most frequent conditions include lichen planopilaris (LPP) with its three types: classic LPP, frontal fibrosing alopecia FFA and the Graham Little syndrome, and pseudopelade of Brocq. Moreover, the cictricial alopecia may be observed in the course of discoid lupus erythematosus (DLE), folliculitis decalvans and dissecting folliculitis, also called perifolliculitis capitis abscedens et suffodiens (PCAS).

Permanent hair loss may also be observed in people with acne keloidalis nuchae, acne necrotica and with erosive pustular dermatosis. Cicatricial alopecia may be secondary to other conditions, including inflammatory, autoimmune diseases or malignancy.

Symptoms
The aforementioned diseases have one common feature – untreated patients develop areas of hairless, scar-resembling skin. Sometimes it is preceded by skin inflammation, which incline the patient to seek medical advice. In other cases, the onset of the disease may pass unnoticed, which results in a delayed diagnosis and implementation of treatment.

Course of disease
Most of the aforementioned diseases are chronic and progressive. Sometimes, such as in the case of dissecting folliculitis, acute inflammation symptoms dominate at first. Cicatricial alopecia is a permanent condition (cannot be reversed).

Diagnosis
The diagnosis is based on the analysis of the clinical picture and trichoscopy procedure.

Treatment
Due to a great variety of pathological mechanisms in the aforementioned conditions, various drugs are used in treatment. In most cases, intensive topical treatment is required, often in combination with general treatment.