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- Presentation
Intralesional Injections for Scarring Alopecias
Description
Professor Jerry Shapiro discussed the use of intralesional injections as a treatment for various types of scarring alopecias during a recent presentation. He first covered lichen planopilaris (LPP), highlighting that for patients with less than 10% scalp involvement, he employs monthly intralesional corticosteroid injections (10 mg per cc, 2 cc max) combined with a topical mixture of tacrolimus, clobetasol, and minoxidil. For those with more extensive involvement, treatments include doxycycline (20 mg), hydroxychloroquine, and if necessary, additional options like pioglitazone and excimer laser therapy. He then transitioned to frontal fibrosing alopecia, emphasizing the importance of careful administration of lower-dose corticosteroid injections across the scalp. The presentation also touched on folliculitis decalvans, where corticosteroids are paired with antibiotics for optimal management. Lastly, he addressed dissecting cellulitis, recommending a combination of injections and isotretinoin. Overall, Shapiro detailed a comprehensive approach to using intralesional corticosteroids while emphasizing safety and tailored treatment regimens for the effective management of scarring alopecias.
View moreConclusions
- Intralesional corticosteroid injections, particularly with triamcinolone acetonide (IL-TAC), are effective in treating scarring alopecias such as lichen planopilaris (LPP) and frontal fibrosing alopecia (FFA).
- A treatment regimen for LPP includes a maximum of 20 mg of triamcinolone per month, often combined with antibiotics like doxycycline or hydroxychloroquine to manage inflammation.
- For patients with more extensive scalp involvement, a combination therapy with adjust dosages and various anti-inflammatory agents is recommended.
- Lower concentrations of IL-TAC are utilized particularly at the frontal hairline to reduce side effects like atrophy, while higher concentrations can be used at other scalp areas.
- Measurement of disease progression is essential, with specific baseline and follow-up evaluations to track the effectiveness of treatments.
- In treatment-resistant cases, alternative therapies such as pioglitazone, naltrexone, and other systemic medications are considered.
- Intralesional injections show promise in managing more complex scarring alopecias like dissecting cellulitis and folliculitis decalvans, combining IL-TAC with antibiotics and potentially surgery for drainage.
- Svigos K, Yin L, Fried L, Lo Sicco K, Shapiro J. A Practical Approach to the Diagnosis and Management of Classic Lichen Planopilaris. Am J Clin Dermatol. 2021;22(5):681-692. doi:10.1007/s40257-021-00630-7
- Mubki T, Rudnicka L, Olszewska M, Shapiro J. Evaluation and diagnosis of the hair loss patient: part I. History and clinical examination. J Am Acad Dermatol. 2014;71(3):415.e1-415.e15. doi:10.1016/j.jaad.2014.04.070
- Otberg N, Kang H, Alzolibani AA, Shapiro J. Folliculitis decalvans. Dermatol Ther. 2008;21(4):238-244. doi:10.1111/j.1529-8019.2008.00204.x
- Fabris MR, Melo CP, Melo DF. Folliculitis decalvans: the use of dermatoscopy as an auxiliary tool in clinical diagnosis. An Bras Dermatol. 2013;88(5):814-816. doi:10.1590/abd1806-4841.20132129
- Pirmez R. The dermatoscope in the hair clinic: Trichoscopy of scarring and nonscarring alopecia. J Am Acad Dermatol. 2023;89(25):S9-S15. doi:10.1016/j.jaad.2023.04.033