Diagnostic Challenges and Treatment Strategies in Neutrophilic Cicatricial Alopecias: A Narrative Review from Conventional Therapies to New Therapeutic Targets

This narrative review addresses the diagnostic challenges and treatment strategies for neutrophilic cicatricial alopecias, specifically folliculitis decalvans (FD) and dissecting cellulitis of the scalp (DCS), which lead to chronic inflammation and irreversible hair loss. Accurate diagnosis is crucial for effective management, as FD and DCS require different therapeutic approaches due to their distinct pathogenic mechanisms. Conventional treatments, such as antibiotics for FD and isotretinoin for DCS, often result in partial responses and frequent relapses. Emerging therapies, including biologics like TNF-α inhibitors and JAK inhibitors, show promise in managing refractory cases by targeting specific inflammatory pathways. The review emphasizes the need for phenotype-driven treatment strategies, a multimodal diagnostic approach, and further studies to develop standardized treatment protocols and confirm long-term outcomes.