Kristen Lo Sicco, MD, on the Urgent Need to Address and Treat Lichen Planopilaris

In a conversation with Dermatology Times, Kristen Lo Sicco, MD, emphasized the urgency and clinical significance of primary cicatricial alopecias, describing them as “trichologic emergencies,” a term originally coined by her mentor, Jerry Shapiro, MD. This designation reflects the critical need for early recognition and prompt intervention, as these conditions can lead to irreversible follicular destruction and permanent hair loss if left untreated. Lo Sicco, associate professor of dermatology at the Ronald O. Perelman Department of Dermatology at New York University (NYU) Langone Health and the clinical director of the NYU Skin and Cancer Unit, underscored that timely, often multimodal therapy is essential to preserve hair follicles and prevent progression to fibrosis.

“This is something that we look at very seriously in dermatology,” Lo Sicco said. “Don't wait to treat them, because they can result in irreversible damage...We can't get that hair back.”

Focusing on lichen planopilaris (LPP), she highlighted the substantial disease burden associated with this condition. Patients frequently experience symptoms such as pruritus, pain, burning, and scalp dysesthesia, accompanied by clinical signs of inflammation, including perifollicular erythema and scaling. Beyond physical symptoms, LPP has profound psychosocial implications, as progressive hair loss can significantly impact identity and quality of life. Lo Sicco strongly challenges the misconception that hair disorders are merely cosmetic, noting that LPP is often associated with systemic conditions, such as autoimmune thyroid disease, and should be recognized by insurance providers as a serious medical disorder warranting appropriate treatment.

A major barrier in the management of LPP is the absence of FDA-approved therapies. This gap contributes to variability in treatment approaches and creates significant challenges in securing insurance coverage, even for therapies supported by clinical evidence. Lo Sicco points to emerging data, including studies on topical Janus kinase inhibitors, that demonstrate efficacy in related conditions such as frontal fibrosing alopecia. However, without regulatory approval, access to these treatments remains limited, delaying care for many patients.

Importantly, she stressed that delays in treatment initiation may negatively impact outcomes, a concept already well established in non-scarring alopecias. Early intervention may improve therapeutic response and disease control, further reinforcing the concept of scarring alopecias as urgent conditions. She advocates for increased awareness, improved insurance coverage, and continued research aimed at achieving the first FDA-approved therapy for LPP.