What are the treatment options for inflammatory alopecia conditions, such as alopecia areata, discoid lupus erythematosus (DLE), and lichen planopilaris?

From the Guidelines

Treatment options for inflammatory alopecia conditions, such as alopecia areata, discoid lupus erythematosus (DLE), and lichen planopilaris, should prioritize high-potency topical corticosteroids, intralesional corticosteroid injections, and systemic therapies tailored to the specific condition, with the goal of suppressing the inflammatory response and preventing permanent hair loss. For alopecia areata, first-line treatments typically include high-potency topical corticosteroids (such as clobetasol 0.05% foam or solution applied twice daily) or intralesional corticosteroid injections (triamcinolone acetonide 5-10 mg/ml injected into affected areas every 4-6 weeks) 1.

Treatment Options

• High-potency topical corticosteroids, such as clobetasol 0.05% foam or solution, applied twice daily
• Intralesional corticosteroid injections, such as triamcinolone acetonide 5-10 mg/ml, injected into affected areas every 4-6 weeks
• Systemic options, including oral corticosteroids (prednisone 0.5-1 mg/kg/day for 1-3 months with tapering), JAK inhibitors like tofacitinib (5-10 mg twice daily), or immunotherapy with diphenylcyclopropenone, for more extensive cases

Condition-Specific Treatments

• For discoid lupus erythematosus, treatment begins with sun protection and high-potency topical corticosteroids, with antimalarials like hydroxychloroquine (200-400 mg daily) often added for more extensive disease
• For lichen planopilaris, treatment typically includes high-potency topical corticosteroids, intralesional corticosteroid injections, or oral medications like hydroxychloroquine (200-400 mg daily) or oral retinoids

Important Considerations

• Early intervention is crucial to prevent permanent hair loss from scarring and follicular destruction
• Treatment duration varies based on response, and patients should be monitored for potential side effects of medications, particularly with long-term use of corticosteroids or immunosuppressants 1

From the Research

Inflammatory Alopecia Associations

Inflammatory alopecia conditions, such as alopecia areata, discoid lupus erythematosus (DLE), and lichen planopilaris, can be challenging to treat. The following are some treatment options for these conditions:

• Systemic corticosteroids have been shown to be effective in treating severe alopecia areata, with satisfactory hair regrowth achieved in 38.9% of patients 2.
• Hydroxychloroquine (HCQ) is an antimalarial that can be used to treat hair disorders with underlying autoimmune components, including lichen planopilaris, frontal fibrosing alopecia, and alopecia areata, with variable efficacy 3.
• HCQ can also be used to treat discoid lupus erythematosus (DLE) with cutaneous involvement, including alopecia, with successful treatment reported in a case study 4.

Treatment Options for Specific Conditions

• For alopecia areata, treatment options include systemic corticosteroids 2 and HCQ 3.
• For DLE, treatment options include HCQ 4, topical corticosteroids, and oral antimalarials, with or without oral corticosteroids as bridging therapy 5.
• For lichen planopilaris, treatment options include HCQ 3 and other immunosuppressive agents.
• Innovative treatments, such as concentrated growth factors combined with corticosteroids, have also been reported to be effective in treating DLE alopecia 6.

Key Considerations

• Treatment of inflammatory alopecia conditions should be individualized based on the specific condition, severity, and patient characteristics.
• Early diagnosis and timely treatment are crucial to achieve hair regeneration and prevent further disease progression.
• Combination therapies, such as HCQ and corticosteroids, may be more effective than monotherapy in some cases 3, 6.