Primary cicatricial alopecias: An overview on classification, diagnosis and treatment based upon personal experience and literature search

In primary cicatricial alopecias, permanent hair loss replaced by fibrous tissue occurs as a primary event as the follicle is the main target of the disease process. Primary cicatricial alopecia accounts for 5% of all trichologic consultations at the Section of Dermatology, University of Genoa. Considering that hair loss has a strong impact on patients' psychology and quality of life and that cicatricial alopecias can be associated with underlying systemic implications, it is extremely important that every clinician is familial with the diagnosis and treatment of the different types of cicatricial alopecia. An accurate clinical assessment integrated by videodermatoscopy and histopathologic studies permits a high standard performance of correct diagnoses. A simplified classification is considered herein, dividing the cicatricial alopecias into two moin groups: inflammatory and non-inflammatory. The former is further subclassified into a lymphocyte-predominant section including discoid (chronic cutaneous) lupus erythematosus, lichen plano-pilaris and central centrifugal cicatricial alopecia and o neutrophil-predominant section including follicultis decalvans and dissecating cellulitis of the scalp while the latter includes only classic pseudopelade of Brocq The aim of treatment is slowing or stopping the progression of the inflammatory waves and the scarring process at the earliest phase of involvement. As no fully satisfactory, evidence-based medicine regimens for treating cicatricial alopecia is available, the therapy is still based upon the literature review, the personal experience, the expected adverse effects and some pragmatic considerations such as the cost and the patient's compliance.