Abstract
About this talk
Background: Scalp DLE is a “trichologic emergency” as upto 35% patients develop scarring alopecia despite the standard systemic therapy. This is due to the delayed local action of systemic treatments on the DLE plaques. To achieve a faster local response and protect uninjured follicles, the addition of topical therapies is essential.
Aims and Objectives: We evaluated the efficacy of 20% salicylic acid(SA) peel as an adjuvant topical therapy in early active scalp DLE plaques. 20% SA peel due to its keratolytic and sebum reducing properties, resurfaces the epidermis and clears cornified plugs,facilitating new hair growth . This also enhances penetration of topical therapies into the dermis, targeting lymphoid infiltrates in DLE lesions.Additionally, SA peel has an anti-inflammatory property . The irritant action may stimulate proliferation of the basal and inter-follicular stem cells.
Materials and methods:
Study Type - Quasi-experimental (pre-and-post) interventional study.
Patient Details - Seventeen female patients (mean age: 41 years) with early-stage scalp DLE (<4 weeks duration) showing active signs (follicular plugging, scaling, and erythema). All were on oral prednisolone, hydroxychloroquine sulfate (HCQS), and topical 0.1% mometasone furoate.
Intervention - 20% salicylic acid peel application on DLE plaques every 2 weeks until visible hair growth.
Assessment - Each visit included clinical photographs and trichoscopy. DLE activity
(follicular plugging, scaling, erythema) was graded on a 0-4 scale (0 = none, 4 = very severe).
Outcome Measures - Hair growth was assessed using the Investigator’s Global Assessment (IGA) scale as excellent (>75%), good (50-75%), poor (0-25%). Both the scores were calculated on every follow-up and the improvement was noted.
Results: There was a statistically significant (p<0.05) improvement. Initially seen trichoscopically in the form of decreased number of follicular plugs, reduced erythema and scaling by 4 weeks .Later appreciated by a visible hair growth without scarring in 8 weeks - nine patients achieved an excellent growth and the rest eight patients maintained a good growth.
Limitations and Conclusion: In cases of active scalp DLE, 20% SA peel comes to the rescue in rejuvenating the scalp. Thus, improving penetration of the topicals and preventing scarring by buying time for systemic therapy to act.
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