medications include corticosteroids, minoxidil, and calcineurin inhibitors. Topical treatment involves the whole scalp due to possible follicular inflammation in the unaffected scalp.13 Systemic treatments include 5-alpha reductase inhibitors, hydroxychloroquine, and retinoids. Table 1 highlights treatments supported by published data, though smaller studies have highlighted the utility of pioglitazone, methotrexate, naltrexone, and hair transplantation.14 There are currently no approved or validated treatments due to a paucity of randomized trials. Topical treatments for LPPigm include high potency steroids, tacrolimus, and skin lightening creams. Systemic treatments include isotretinoin, tranexamic acid, and vitamin A. Laser treatments and chemical peels are another option, though expensive. Notable studies are highlighted in Table 2. A combination of topical and systemic treatments, robust sunscreen application, and trigger avoidance is likely to yield the best outcomes.15 Treatment for both FFA and LPPigm centers around slowing or preventing progression, and there is a low threshold for starting systemic therapies for patients who prefer an aggressive approach.
