Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with progressive hair loss associated with scalp scarring, erythema, and pruritus. History of [duration] duration. Denies recent trauma, chemical burns, or radiation therapy. Symptoms include [burning/pain/tenderness] in affected areas. No systemic symptoms reported.
Clinical Examination Findings
Scalp examination reveals patches of permanent alopecia with clinical evidence of scarring (loss of follicular ostia). Skin texture appears [atrophic/shiny/indurated]. Erythema and scaling noted at the periphery. Pull test is negative. No evidence of active infection or pustules.
Treatment Protocol
Initiate intralesional corticosteroid injections (triamcinolone acetonide) to stabilize inflammation. Prescribe topical [high-potency steroid/calcineurin inhibitor] twice daily. Consider oral [hydroxychloroquine/doxycycline] for refractory cases. Schedule follow-up for scalp biopsy and assessment of surgical reconstruction candidacy (tissue expansion or excision).