Ronda S. Farah, MD, kicked off the session “Cosmetic and Procedural Interventions for Scarring Alopecia,” at the 2023 AAD Annual Meeting, by reviewing the evidence for scarring alopecia. 

Dr Farah started with injectables and included platelet-rich plasma (PRP), which is used off-label to manage alopecia.” The US Food and Drug Administration (FDA) defines PRP as at least 250,000 platelets/microliter and “there is no standardized protocol for preparing PRP.” Along with unknown mechanism for PRP, there are other unknown variables, such as optimal regimen, optimal white blood cell concentration, and the best method for preparation of PRP. 

“Injectable exosomes cannot be used for patient care for hair at this time,” Dr Farah warned. “There are no human studies of exosomes and alopecia. The FDA regulates regenerative medicine products.”

Dr Farah moved on to light-based procedures and explained photobiomodulation and nbUVB. Photobiomodulation is a low-level laser therapy for treating androgenetic alopecia and FDA approved for men and women. “Photobiomodulation treatment has been tried off-label in frontal fibrosing alopecia/lichen planopilaris with improvement in limited study populations,” she noted.

Dr Farah then touched base on hair transplantation for scarring alopecia, “It may be helpful for those in remission.” In 2016, follicular unit extraction was the most common method of harvesting.

She also discussed other noninvasive procedures such as water-based dermabrasion, which is a suction-based cleansing. “It utilizes water to exfoliate the epidermis and may be vortexed,” she indicated. 

Dr Farah recommended the following changeable serums for scalp health:

• Lactic acid
• Salicylic acid
• Glycolic acid
• Vitamin C
• Tranexamic acid
• HA
• Glucan
• Betaine
• Growth factors

Lastly, Dr Farah referred to microneedling as a noninvasive procedure; however, she cautioned, “There is a lack of data on microneedling and its use on scarring alopecia.”

Reference
Farah RS. Cosmetic and procedural interventions for scarring alopecia. Presented at: AAD Annual Meeting; March 17–21, 2023; New Orleans, LA.