Topical Tacrolimus, Clobetasol, and Minoxidil (TCM) for Primary Cicatricial Alopecias: A Retrospective Analysis of Clinical Outcomes and Safety

Introduction: Primary cicatricial alopecias (PCAs) cause permanent hair loss and psychosocial distress. Management involves anti-inflammatory and hair growth–promoting therapies. A combination of tacrolimus, clobetasol, and minoxidil (TCM) may offer synergistic benefits by targeting distinct inflammatory pathways while increasing background hair density for improved camouflage. This study evaluates the safety and efficacy of TCM use in PCA patients. Methods: We conducted a retrospective chart review of PCA patients aged 18+ years treated with TCM between 1/1/2009-5/31/2025. Outcomes included inflammatory activity on trichoscopy, scalp symptoms, provider- and patient-reported disease status, and objective hair measurements. Descriptive statistics were performed using SAS v9.4. Results: Eighty-two patients (80.5% female, mean age 61.5) were included, most commonly with frontal fibrosing alopecia or lichen planopilaris. TCM was typically prescribed as a compounded solution used 1-2 times/day for an average of 24.5 months. Adverse effects included worsened itch/burning (6.1%), hypertrichosis (4.9%), scalp irritation/dryness (4.8%), and atrophy (3.7%); most (62.2%) experienced no adverse effects. Provider-assessed inflammation and disease status improved or stabilized in 69.5% and 76.9%, respectively. Objective hair measurements also improved. Conclusions: TCM is well-tolerated and, used alone or in conjunction with other therapies, appears to be effective. Improvements were seen in provider-reported outcomes and objective hair measurements.