Treatment of DLE, LPP, and CCCA

Treatment for lupus, LPP, and CCCA depends on scalp involvement extent. For cases with less than 10% scalp involvement, topical and injectable steroids are typically used. Injectable steroids (2-10 mg/ml) are administered into scarred areas monthly, and potent topical steroids are applied twice daily. If there’s no response after eight weeks, hydroxychloroquine (200 mg twice daily) or doxycycline (100 mg BID) may be added for at least six months. In rapidly progressive alopecia cases, prednisone (1 mg/kg/day) is given and tapered over two months as bridge therapy until hydroxychloroquine takes effect.
For cases with more than 10% scalp involvement, multiple treatments, including topical steroids, injectable steroids, and hydroxychloroquine, are typically started immediately. Prednisone can also be added in rapidly progressive cases. If no improvement occurs after six months, other treatments like isotretinoin, dapsone, and thalidomide may be considered. Hair restoration should only be considered with a negative pull test for over two years and stable hair loss. While topical and oral minoxidil’s benefits for cicatricial alopecia remain unclear, they have been used as adjunctive therapy.