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Scarring alopecia is a rare type of hair loss characterized by permanent damage to the hair follicles and scarring of the scalp. The hair follicles fail to regenerate, and as a result , permanent hair loss occurs on the affected areas. There can be multiple causes of scarring alopecia, it is a group of diseases. The second type of alopecia is the so-called non-scarring alopecia, which includes, for example, the previously described androgenetic alopecia or alopecia areata.
Facts
- Scarring alopecia causes permanent loss of hair follicles
- In the case of scarring alopecia, it is typically not possible to restore hair growth
- Primary scarring alopecia is caused by inflammation or autoimmune disease
- Secondary scarring alopecia occurs as a result of damage to the skin, e.g. after burns or a tumour
- Treatment must be immediate and combined, aimed at stopping the spread of bald spots
- Hair transplantation can only be performed if the scarring alopecia is no longer active
How does scarring alopecia manifest itself?
Scarring alopecia manifests itself on the scalp in the form of permanent bald patches and scars. Hair follicles are replaced by scars that are unable to produce new hair. Patients often experience burning or itching of the scalp, which sometimes develops into hair soreness (trichodynia). In some types of scarring alopecia, pustules – may form. Dandruff often appears in the affected area. That’s why, unfortunately, I regularly encounter patients in my practice with scarring alopecia that was previously misdiagnosed as seborrheic dermatitis.
Who is in the risk group?
Scarring alopecia can affect both men and women, although women are generally more prone to this condition. There are certain factors that can increase the risk of scarring alopecia. These include genetic predispositions, head injuries, autoimmune diseases, skin infections and inflammatory skin diseases.
The most common causes of primary scarring alopecia
Lichen planopilaris
One of the most common causes of scarring alopecia; the exact cause of lichen planopilaris is not clear. It is thought to be a cytotoxic autoimmune response to an unknown antigen in the hair follicles. It may also affect other hairy areas of the body, such as the eyebrows and axillae.
Frontal fibrosing alopecia
(Frontal Fibrosing Alopecia, FFA) – affects the front hairline, eyebrows or even the underarms, especially in postmenopausal women. This type of alopecia was first described in 1994 and has been on the rise ever since. In rare cases, it can also affect men.
Chronic cutaneous lupus erythematosus
(CCLE) – autoimmune connective tissue disease. In most cases, it is only a skin problem. However, in a small percentage of patients, this disease may be associated with systemic lupus erythematosus. In this form of scarring alopecia, in some cases, the hair may regrow.
Folliculitis decalvans
– a chronic inflammatory disease thought to be caused by an abnormal immune system response to Staphylococcus aureus (golden staph).
Central centrifugal cicatricial alopecia
(CCCA) – the exact cause of CCCA is unknown. The disease is probably caused by several factors and their combinations. It is often associated with the use of chemical hair products, curling irons, and excessively tight ponytails.
How is scarring alopecia treated?
Treatment of scarring alopecia is usually challenging and depends on the severity of the condition and the cause. Unfortunately, there is no universal cure for scarring alopecia. However, there are several options that can help minimize its effects. However, this is always only to protect the parts of the skin where the hair has not yet fallen out.
The treatment of scarring alopecia involves, for example, the use of corticosteroids, which are applied topically or intralesionally (injected) to the affected scalp. They help to suppress inflammation and its further spread. The list of possible medications is wide and the first-choice drugs vary for each condition. In some cases, a hair transplant may be performed, but this is only if the scarring alopecia is no longer active.
Supportive treatment options
Psychological help and support is a very important part of treatment. Scarring alopecia is very stressful, so patients commonly show signs of depression and feelings of helplessness. Apart from hair transplantation, there is no other way to restore hair growth on the affected parts of the head. Therefore, in the case of extensive hair loss, patients often opt for wigs (some insurance companies contribute to their purchase) and hairpieces, or they wear scarves, which are also popular among patients with non-scarring forms of alopecia.
It is essential that patients with scarring alopecia consult a dermatologist specialising in hair diseases. In this way, they can obtain a correct diagnosis and an individual treatment plan that will ideally prevent the bald patches from spreading. Each case of scarring alopecia is completely unique, so the treatment of the disease and patient care must be approached individually.
