Clinical Pearls for Spotting Alopecia Scarring Early, with Maria Hordinsky, MD

At the 2025 SDPA Annual Summer Dermatology Conference in Washington, DC, the HCPLive editorial team interviewed Maria Hordinsky, MD, regarding the biggest takeaways from her conference talk titled ‘Spotting Scarring Alopecia Early: Clues, Challenges, and Clinical Pearls.’

Hordinsky, an R.W. Goltz Professor at the University of Minnesota Department of Dermatology, discussed some of the points of her session on spotting alopecia scarring early, highlighting different aspects for clinicians to keep in mind. First, given that scarring alopecia is notoriously difficult to catch early, Hordinsky was asked what the earliest clinical or patient-reported signs that raise red flags for clinicians would be.

“Some of the early signs might be symptoms like pain, burning, or itch in a certain part of the scalp,” Hordinsky explained. “And then clinically, when one looks at the scalp, one may see inflammation around the hair follicles and perhaps only redness in the general area of involvement, as well as scalp hair loss. Catching things early, before they spread, is really important.”

The HCPLive team also asked Hordinsky about how subtle symptoms can be differentiated from more common non-scarring conditions.

“That is a great question, because many people have what's called seborrheic dermatitis, or dandruff, so to speak,” Hordinsky said. “So they could have dandruff or seborrheic dermatitis all over their scalp just as an underlying baseline. Then when they get a scarring alopecia, there is even more inflammation in a certain area of the scalp where that inflammatory scarring alopecia is occurring. So basically, you have to treat the whole scalp when you approach patients with these conditions.”

Hordinsky was also asked what clinicians now understand about the earliest stages of follicular destruction in scarring alopecias and about ways this may inform earlier intervention.

“We've known for decades that the inflammation in scarring alopecia is in the stem cell region, or the bulge region of the hair follicle,” Hordinsky explained. “So that's in the upper third of the hair follicles. We've all known that for a long time, and now people are understanding what those cells are that are coming in there. We've known also for years that these are primarily cells called lymphocytes. But now people are starting to understand what kind of lymphocytes these are…So the science is moving forward to understand better what these cells are and how to better target them, and what these cells release, so that this also could be targeted in treatments.”

For any further information on scarring alopecia covered in Hordinsky’s presentation at SDPA 2025, view her full interview segment posted above. To find out more about alopecia and other dermatologic diseases highlighted at the meeting, view the latest conference coverage.

The quotes used in this interview summary were edited for the purposes of clarity.