In this episode of Derms and Conditions, host James Q. Del Rosso, DO, welcomes Andrea Murina, MD, to discuss the early recognition and management of scarring alopecias. Their conversation explores why these conditions can be missed in their earliest stages, the clinical clues that help distinguish scarring from nonscarring alopecias, and approaches to diagnosis and treatment aimed at preventing permanent hair loss.

Dr Murina reflects on how outdated perceptions that little could be done once scarring occurred motivated her to focus on these conditions. She explains that recognizing patients earlier in the disease course provides an opportunity to intervene before irreversible follicular destruction develops, setting the stage for a discussion of the timing, patterns, and diagnostic tools that support earlier diagnosis.

They review the major categories of cicatricial alopecia, highlighting the relative ease of identifying neutrophilic disorders such as folliculitis decalvans and dissecting cellulitis, while noting that early lymphocytic disorders such as central centrifugal cicatricial alopecia (CCCA) and frontal fibrosing alopecia may initially resemble more common nonscarring conditions.

Dr Murina next overviews the value of trichoscopy. She explains how dermatoscopic findings, including perifollicular scale, telangiectasias, follicular plugs, and changes in hair diameter, can help distinguish scarring from nonscarring alopecias, guide biopsy decisions, and improve biopsy yield by identifying the most inflamed follicles for sampling.

The episode also reviews treatment strategies for common scarring alopecias. For CCCA, Dr Murina typically begins with topical and intralesional corticosteroids, adding doxycycline and antifungal shampoos when appropriate. For lichen planopilaris, she follows a similar approach while incorporating systemic therapies such as hydroxychloroquine, finasteride, or dutasteride. The discussion concludes with discoid lupus erythematosus, where she emphasizes that early treatment with high-potency topical and intralesional corticosteroids, along with appropriately dosed hydroxychloroquine, can produce meaningful improvement.

Tune in to the episode to hear Dr Del Rosso and Dr Murina share diagnostic pearls, trichoscopic clues, biopsy strategies, and treatment approaches that can help clinicians identify scarring alopecias earlier and intervene before permanent hair loss occurs.

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Disclaimer: The views expressed in this episode are those of the speakers and do not necessarily reflect those of Dermsquared.

This program is intended for health care professionals and is provided for educational purposes only. It should not be interpreted as specific treatment recommendations. Clinicians are responsible for applying independent clinical judgment in patient care.