The Hair Necessities- Scarring Alopecia Conference (July 18^th, 2020)

On Saturday, the Cicatricial Alopecia Research Foundation (CARF) hosted their first-ever virtual patient conference: The Hair Necessities. The conference was a series of talks, each followed by live Q and A with the presenters. The conference focussed on three major types of Scarring Alopecia: Frontal Fibrosing Alopecia (FFA), Lichen Planopilaris (LPP) and Central Centrifugal Cicatricial Alopecia (CCCA).

The first speaker was Dr Wilma Bergfeld, a Professor of Dermatology at the Cleveland Clinic. Dr Bergfeld opened by describing a bit about scarring alopecias and their symptoms, and really reinforced the idea that FFA is on the increase, stating that FFA is an epidemic. She also mentioned some of the conditions commonly associated with scarring alopecias, like vitiligo and thyroid disease.

Following on from Dr Bergfeld’s presentation, Dr Maryanne Senna, a dermatologist at Harvard Medical School gave a fantastic overview of some of the treatments for scarring alopecias, suggesting that for acute treatment, combined therapies (i.e. more than one treatment at the same time) were best. She also described some of the more experimental treatments, including low dose naltrexone, excimer laser and hydroxychloroquine. Dr Senna’s presentation was comprehensive and there were more questions for her than could be answered in the time.  

Next up was a talk from Professor Angela Christiano and Dr Lindsey Bordone, from Columbia University. Dr Christiano talked about the genetic basis for scarring alopecias. Dr Christiano  discussed how development of a scarring alopecia requires both a genetic predisposition and an environmental trigger, using the idea of making a fruit smoothie to explain how each element was required to develop the right conditions for a particular type of scarring alopecia to develop. Dr Lindsey Bordone came after Professor Christiano and she discussed the use of JAK-inhibitors for Lichen Planopilaris and presented some of the results of her small scale study, showing that the majority of people with LPP who were treated with Tofacitinib (a JAK inhibitor) showed improvements in their symptoms (see here for the paper). She also discussed the impact of COVID-19 on people with scarring alopecia.

The next presentation came from Dr Nicole Rogers, who spoke about surgical treatments for patients with scarring alopecia, emphasising that transplantation is not appropriate for everyone with scarring alopecia, although it can be helpful for people whose condition is under control. After Dr Rogers came Dr Jerry Shapiro, who discussed what to look for in a dermatologist, suggesting that the most important thing to look for is someone with extensive experience in scarring alopecia treatment, who is willing to listen.

Dr Maria Hordinsky discussed the use of Platelet Rich Plasma (PRP) for scarring alopecias. She spoke about PRP, and the emerging science of this type of treatment for many types of hair loss, although this therapy is not yet recommended for use in scarring alopecia.  Dr Ronda Farah then discussed the use of different types of lasers for re-growing hair.

The last to present was Andrea Furgala, who discussed the psychological impact of scarring alopecias.  Andrea herself was diagnosed with LPP in 2015 and has used a technique known as Dialectical Behavioural Therapy to come to terms with the condition. She discussed her approach to managing the emotional side of LPP and other chronic conditions. She explained the emotional pathway from getting your diagnosis to a point of acceptance in a logical and comprehensible way.

The conference was really informative and the take home messages were really important: that some types of scarring alopecia, like FFA are on the rise, but that there are new treatments on the horizon that may help to treat these conditions.