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Scarring Alopecia


Scarring alopecia, also known as cicatricial alopecia, is a condition where there is a potential permanent and irreversible destruction of hair follicles which leads to their replacement with scar tissue. It is a very rare form of alopecia and only occurs among 3% of healthy men and women of all ages.


Most forms of hair loss scarring alopecia start as small patches of hair loss that expand over a period of time. In a lot of cases, hair loss is gradual and without any noticeable symptoms. It also goes unnoticed for a long period of time. However, in some instances, it is associated with severe itching, burning, and progresses very quickly.

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When scarring alopecia is suspected, skin biopsies are done to identify the particular type of alopecia. A 2-4 millimeter biopsy is taken and examined by the dermatopathologists in the laboratory under laboratoryunder the microscope. In the early stages, inflammatory cells will be present around the hair follicles which induces the destruction of scar tissue. After a while, the bald patches stop expanding and all the pain goes away. In the final stage, a biopsy will no longer show any inflammation and only a few longitudinal scars will be left to show where the hair follicles were present.


What causes scarring alopecia?


The scarring alopecia causes are not yet completely known or understood. However, all forms of cicatricial alopecia involve inflammation at the upper part of the hair follicle. This is where the stem cells and the sebaceous glands are located. In cicatricial alopecia, these stem cells and sebaceous glands are destroyed leading to no possibility of regeneration of the hair follicle. Therefore, there is permanent hair loss. The good part is that cicatricial alopecia is not contagious.


Scarring alopecia treatment options are limited. The nature of scarring alopecia treatment depends on the diagnosis and the progressiveness of disease. The ones that have lymphocyte inflammation, such as lichen planopilaris, are treated with corticosteroids in the form of creams or injections. Antimalarial and isotretinoin drugs are also used in some cases. In the case of neutrophils, antibiotics and isotretinoin are used and experimental drugs like cyclosporine and tacrolimus have also been used.


Scarring Alopecia Types

  •   The types of scarring alopecia include primary, secondary, and hereditary.
  • Primary scarring alopecia occurs when hair follicles are destroyed and replaced by fibrous tissue. Since the stem cells in the hair root are destroyed, this type of scarring alopecia leads to irreversible hair loss.
  • Inflammatory cells like lymphocytes, neutrophils, or a combination of these can cause primary scarring alopecia.
  • Secondary scarring alopecia results from damage to hair follicles caused by inflammation. This hair condition occurs when the follicles are destroyed due to burns, trauma, or radiation therapy.


Symptoms of Scarring Alopecia

  • Scarring alopecia begins with the development of shiny and smooth bald patches on the scalp which eventually lead to almost total baldness.
  • There is itching and a burning sensation on the scalp.
  • Pain is experienced in the scalp region.
  • This hair condition may cause pus in the scalp region.
  • Scarring alopecia symptoms also include blisters and crusting on the scalp.
  • Patches of rough and scaly skin may be seen.


The main sign of cicatricial alopecia is hair loss. It usually results in localised hair loss, which means you lose hair in patches. Hair loss can begin gradually and progress over time. It might also begin abruptly and swiftly.

  • Scarring alopecia most commonly affects the scalp, but it can occur anywhere there is hair.

In addition to hair loss, some patients suffer from skin issues such as:

  • Bleeding.
  • Blistering.
  • Burning.
  • Scaling or crusting.
  • Itching, tingling, or tenderness are all possible symptoms.
  • Pustules.
  • Discoloration or redness.


Scarring Alopecia Treatment

  • Corticosteroids may be injected into the inflammatory lesion, as a treatment for alopecia, as this method helps control hair loss.
  • Ils Injections for Alopecia: Injections filled with steroids and immunosuppressants are also used to treat this condition.
  • Sun protection for the scalp is often recommended.
  • Using shampoo may help in treating hair conditions.


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