Scarring Alopecia

  • Best ResultsVariable
  • Treatment RecoveryNA
  • Procedure TimeVariable
  • Skin SpecialistDermatologist
  • Duration of ResultsVariable
  • AnaestheticNA
  • Back to Work1-2 days
  • Cost$

Scarring Alopecia

In rare cases, hair loss or alopecia is due to inflammation of the hair follicles, resulting in destruction. This is termed scarring alopecia. Dermatologists diagnose & manage all forms of hair loss including lupus, lichen planopilaris, Folliculitis deCalvans & other causes of inflammation. In many cases scarring alopecia can be associated with androgenetic alopecia. The aim of treatment for all forms of hair loss is to slow down hair fall at the earliest stages. 

FactsFacts on Scarring Alopecia

  • Scarring alopecia permanently destroys hair follicles
  • Destruction of follicles is mediated via inflammation
  • Common causes include lichen planopilaris, lupus & inflammatory folliculitis
  • Early & effective medical management can halt or markedly slow down hair fall
  • Your dermatologist will discuss various treatment options
  • Hair restoration surgery can be consider in some cases
  • Most specialists would not consider surgery until 2 years post quiessence

What is scarring alopecia?

The term scarring alopecia refers to a group of dermatological conditions that destroy hair follicles. The outcome is permanent hair loss. Although more commonly seen in women, scarring alopecia can occur in both sexes.

This destructive process may be asymptomatic, namely hair loss is gradual with no symptoms.In other cases, the hair loss is rapidly progressive and associated with itching, burning and pain/discomfort. Examples include lichen planus, lupus & folliculitis.

Because the inflammation that destroys the follicle is below the skin surface, there is usually no visible “scar” on the scalp.  Instead, end stage scarring alopecia is characterised by smooth, shiny areas devoid of hair follicles. In early stage scarring alopecia clinical features such as scale, redness (inflammation), & pustules / pimples may be present.

What are the common types of scarring alopecia?

There are over 80 causes of scarring alopecia. Your dermatologist will be super familiar with most of them. A classification of all cases is beyond the scope of this landing page. The most common causes include-

  • Lichen planus/ frontal fibrosing alopecia
  • Lupus
  • Folliculitis deCalvans
  • Traction alopecia
  • Central centrifugal alopecia
  • Morphea
  • Tumid lupus, tumors, post radiotherapy

Who is affected by scarring hair loss?

Cicatricial alopecia occurs in both men and women. Although it can affect anyone of any age, it is not usually seen in children (unless due to marked inflammatory tinea).   Cicatricial alopecias are not contagious and, in general, they are not associated with other illnesses. The majority of patients with cicatricial alopecia have no family history of a similar condition.

A common form of scarring alopecia affects postmenpausal women; namely frontal fibrosing alopecia. It presents as progressive hair loss of the eyebrows, temporal & frontal hair lines. Some cases are itchy, others describe a burning sensation, whilst some are asymptomatic.

Who to see for a diagnosis?

Your dermatologist can examine your pattern of hair loss & guide you accordingly. Some cases are easily diagnosed due to the pattern of hair loss. An example is frontal fibrosing alopecia or FFA (eyebrows, frontal & temporal hair loss). In other cases special biopsies are required. Be guided by your physician.

Disclaimer: I do not treat hair loss with medical management. For a diagnosis & management plan, please see my colleagues at Clinic Cutis.

Davin’s Viewpoint on Scarring Alopecia

Management is medical. Early & effective therapy will prevent permanent hair loss. With this group of hair loss conditions, inflammation knocks out the germ & stem cells in hair follicles. Inflammation may be acute or in many cases insidious.

There are times when patients want to have a go at treating hair loss with fluffy stuff like herbs, vitamins, diet, meditation, acupuncture, fairy dust & other natural remedies. Probably not a good idea with this group of hair loss disorders. Once the follicle is destroyed, it is gone. Forever. We are probably two to three decades away from true stem cell follicular cloning, so replacement of destroyed follicles can only be achieved with repurposing hair from other areas. Transplant specialists will not consider surgery for at least 2 years after activity has subsided.

In summary, be guided by your dermatologist as to the best course of action. In some cases there may be dual pathology, namely inflammation & gender specific patterned hair loss.

Disclaimer: I am a procedural dermatologist, please see a medical dermatologist for management of this group of conditions.

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