Scarring alopecia (cicatricial alopecia) is a rare but serious condition where hair follicles are permanently destroyed and replaced with scar tissue. Unlike other types of hair loss where follicles remain dormant, scarring alopecia eliminates the follicle entirely — making early diagnosis and treatment crucial to preserve remaining hair.
The condition is caused by inflammatory processes that target the upper part of the hair follicle where stem cells reside. Once these stem cells are destroyed, the follicle cannot regenerate.
Early treatment can save follicles that would otherwise be permanently lost.
Slowly progressive recession of the frontal hairline, often with eyebrow loss. Increasingly common, particularly in postmenopausal women. Believed to be a variant of lichen planopilaris.
An inflammatory condition causing patchy hair loss with perifollicular scaling and redness. Follicles show a characteristic "tufting" pattern where multiple hairs emerge from a single opening.
Begins at the crown and expands outward symmetrically. The most common scarring alopecia in women of African descent. May be associated with hair care practices.
Lupus-related scarring with distinct round, scaly plaques that heal with scarring. Can occur on the scalp alone or as part of systemic lupus.
Bacterial infection-driven inflammation that leads to tufted hair (multiple hairs from one follicle), pustules, and progressive scarring. Often chronic and difficult to treat.
The goal of treatment is to stop the inflammatory process and prevent further follicle loss. Lost hair cannot be regrown.
Topical or intralesional corticosteroids to reduce active inflammation. First-line treatment for most types.
Hydroxychloroquine, methotrexate, or mycophenolate for more aggressive or widespread disease.
For folliculitis decalvans and other infection-associated types. Often requires long-term courses.
Used off-label for frontal fibrosing alopecia. May help slow hairline recession in some patients.
Once the disease has been inactive for 1-2+ years, hair transplant may be considered. Success rates are lower (~50-70%) and disease may reactivate.
Scalp micropigmentation or hair systems can provide cosmetic coverage for permanently affected areas.
Once follicles are destroyed and replaced by scar tissue, hair cannot regrow in those areas. This is why early diagnosis and treatment are critical — the goal is to stop the inflammation before more follicles are lost. Hair transplants may be possible in some cases once the disease is inactive (burned out), but success rates are lower than for other types of hair loss.
Scarring alopecia is caused by inflammatory processes that destroy the hair follicle stem cells. The inflammation can be triggered by autoimmune conditions (lichen planopilaris, frontal fibrosing alopecia), infections (bacterial or fungal folliculitis), physical trauma (burns, radiation), or other inflammatory skin conditions (lupus, sarcoidosis). The exact trigger is often unknown.
Diagnosis typically requires a scalp biopsy, where a small sample of scalp tissue is examined under a microscope. Key signs include: destroyed hair follicles replaced by fibrosis (scar tissue), perifollicular inflammation, and loss of follicular ostia (the pore openings). Trichoscopy (dermoscopy of scalp) can also reveal characteristic patterns.
Scarring alopecia is relatively rare, accounting for approximately 3-7% of all hair loss cases seen in dermatology clinics. Frontal fibrosing alopecia has been increasing in prevalence in recent decades, particularly in postmenopausal women. Central centrifugal cicatricial alopecia (CCCA) is the most common form in women of African descent.
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