Progressive hair loss
A specific hair-loss pattern and the patient’s age and gender pointed to the diagnosis.
Numerous Tx strategies exist, but they are not well studied
Because there are no published randomized clinical trials on treatment for FFA, few evidence-based treatment strategies exist.6 In addition, the prognosis is variable. Experts have employed numerous treatment strategies, including topical and intralesional steroids, immunosuppressive medications, antibiotics, and anti-androgen therapy, with varying results.4,6 For most primary care physicians, it’s best to refer patients to a dermatologist to initiate treatment.
Intralesional steroids such as triamcinolone acetonide (5-10 mg/cc), as well as high-potency topical steroids, are generally helpful to stabilize the disease. There is also some evidence of benefit from oral dutasteride or finasteride at variable doses.6 Immunosuppressants such as hydroxychloroquine may also be used as second-line treatments, although the benefit-to-risk ratio needs to be taken into consideration.7
Early detection is key. In general, treatment should be initiated as soon as possible to prevent disease progression and reduce permanent scarring and hair loss. The Lichen Planopilaris Activity Index7 is a tool that clinicians can use to measure disease severity and track changes in disease activity through patient report of symptoms and measurements of scalp inflammation.
Our patient was started on a regimen of topical high-potency steroids (clobetasol foam, 0.05%), with targeted, intralesional injection of steroids (10 mg/cc of triamcinolone acetonide) to areas with the most inflammation. The patient was advised to use ketoconazole 2% shampoo while showering.
These interventions decreased our patient’s symptoms dramatically. Her scalp erythema and scale improved, but the hair did not regrow. One year later, her hairline was clinically stable with no evidence of disease progression. She continues to see a dermatologist annually.
CORRESPONDENCE
David V. Power, MB, MPH, Department of Family Medicine and Community Health, University of Minnesota, 516 Delaware St. SE, Minneapolis, MN 55455; power007@umn.edu.
