Clinical features of 109 patients with primary cicatricial alopecia: a 15-year retrospective study

Given the limited data on primary cicatricial alopecias (PCAs), which cause permanent hair loss, this study investigates the demographic and clinical characteristics, applied treatments, and disease course of PCA patients.

Medical records of 109 PCA patients that attended an outpatient clinic between 2010 and 2025 were retrospectively reviewed. Demographic and clinical characteristics, and treatment approaches were retrieved from patient files.

Lymphocytic PCA (83.5%) was the most frequent type, followed by neutrophilic PCA (15.6%). Classic lichen planopilaris (LPP-C) was the leading lymphocytic subtype (39.4%), and folliculitis decalvans (12%) was the most common neutrophilic PCA. Lymphocytic PCAs showed female predominance, whereas male predominance was present in neutrophilic PCAs (p < 0.001). Disease onset occurred at an older age in lymphocytic PCAs compared to the neutrophilic group (42.0 ± 11.8 and 30.2 ± 11.4 years, p < 0.001). Pain and nodule/pustule formation were more frequent in neutrophilic PCAs (p < 0.001). Topical/intralesional corticosteroids and hydroxychloroquine were mainly used in lymphocytic PCAs, whereas oral antibiotics and isotretinoin were preferred in neutrophilic PCAs.

PCA frequency may vary geographically. LPP-C was the most common subtype. Early diagnosis and timely treatment are essential to prevent irreversible hair loss and optimize cosmetic outcomes.