Scarring Alopecia: Symptoms, Causes & Treatment
We know: Hair loss is never fun to deal with. But not all hair loss is created equal.
There are actually a few forms of hair loss, and it’s important to know which type of hair loss you have so you can figure out the right treatment option. Of these various types of hair loss (also known as alopecias), 73 percent are non-scarring alopecia, and the other 27 percent are scarring alopecia.
If you’ve been experiencing patches of hair loss with signs of inflammation along your scalp, you may be part of the 27 percent who have scarring alopecia (also known as cicatricial alopecia).
This guide will walk you through what triggers scarring alopecia, as well as what it looks like and whether it’s possible to reverse scarring alopecia.
What Is Cicatricial Alopecia (Scarring Alopecia)?
Scarring alopecia or cicatricial alopecia (CA) is hair loss characterized by, well…scarring, along with signs of inflammation.
Scarring alopecia symptoms usually result in bald patches, sometimes with rough or textured areas surrounding the hair loss. Instead of a smooth balding head, you may notice follicular ostia (damage to the hair bulb). And previously smooth hair follicles might revert to scar-like fibrous tissue.
The different types of scarring alopecias are further classified as primary or secondary.
Primary cicatricial alopecia. Also known as primary scarring alopecia, this type of scarring alopecia is characterized by inflammation seen specifically at the hair follicle.
Secondary cicatricial alopecia. This typically occurs as a side effect when there’s broader damage to the scalp (from a burn or radiation, for example).
The most common forms of scarring alopecia include frontal fibrosing alopecia and lichen planopilaris.
Not to be a Debbie Downer, but we want to give it to you straight: Regardless of the type of scarring alopecia, these hair disorders usually lead to irreversible hair damage and permanent hair loss.
But since some versions of scarring alopecia may not have telltale signs, you’ll need a diagnosis (often consisting of a scalp biopsy) from your dermatologist or another healthcare provider.
In primary cicatricial alopecia, you might see a few types of classifications. Examples of lymphocytic forms include:
Lichen planopilaris. The most common cause of cicatricial alopecia, this condition makes up about 10 percent of cases. It often looks like itchy patches and blisters, and affected areas beyond the scalp are also possible.
Chronic cutaneous lupus erythematosus. This is seen as both single and multifocal patches, along with depigmentation and follicular plugging.
Central centrifugal cicatricial alopecia. Burning, scaling and itching on the skin surface are common side effects of this scalp condition. It may look similar to signs of female pattern baldness.
Frontal fibrosing alopecia. As the name suggests, this condition usually presents itself in the frontal hairline, but it can also occur in the eyebrows. It typically affects postmenopausal women.
Brocq pseudopelade. This condition is often seen as small or irregular bald patches, typically with no other symptoms.
Forms of neutrophilic cicatricial alopecia include:
Dissecting cellulitis of the scalp. Seen with multiple nodules on the scalp, often with discharge, this hair disorder is most common among Black adolescents and adult males.
Folliculitis decalvans. Often seen as one single patch of hair loss that grows bigger over time, folliculitis decalvans can also result in pustules and honey-colored crusting. It’s believed to occur from a bacteria called Staphylococcus aureus.
It’s worth noting that if you’re of African descent, certain conditions (like central centrifugal cicatricial alopecia, acne keloidalis nuchae and dissecting cellulitis of the scalp) may be more common.
Scarring alopecia was once thought to be related to haircare practices, like using hot combs, relaxers or hairstyles that cause excessive tension. But it’s now understood that scarring hair loss can occur for other reasons (or without a known cause).
Scarring Alopecia vs. Other Alopecia Types
Cicatricial alopecia is fairly rare compared to other forms of hair loss, like female pattern hair loss. As such, it’s important to note that some other forms of hair loss may initially resemble scarring alopecia, but in fact, they may have different causes.
For instance, two other types of hair loss that can also cause sudden, irritated patches of baldness are traction alopecia and alopecia areata.
Remember, having an understanding of the type of hair loss you have will help you determine the right game plan to treat it.
Alopecia Areata
Alopecia areata can look similar to scarring alopecia in that it usually shows up as bald patches (rather than diffuse thinning or a wide part). But alopecia areata is a non-scarring alopecia, and often, hair loss can be reversed.
Alopecia areata affects about 2 percent of the population, and it tends to be reported most commonly in women over 45.
This autoimmune disease is associated with various other health issues like thyroid disease, lupus, irritable bowel syndrome, depression and anxiety. In severe cases of alopecia areata, changes even in nails may be seen.
Think this sounds more in line with what you’re dealing with? See our guide to alopecia areata for a deeper dive.
Traction Alopecia
Traction alopecia is another common form of hair loss (aka telogen effluvium, but thankfully, it can often be reversed. It’s a result of pulling hairstyles, like braids, tight buns and ponytails, which can cause trauma to the hair follicle over time due to the continuous tension.
Keep in mind you’ll have to switch to looser styles to mitigate hair loss — otherwise, those strands will be finito. Learn more about the condition and how to treat it in our comprehensive guide to traction alopecia.
P.S. It’s also worth noting that alopecia, in general, is not a one-size-fits-all situation. There are so many different alopecia types — learn all about them in our blog.
What Causes Scarring Alopecia?
There are various types of scarring alopecia. Each has multiple underlying issues at play, but typically, inflammation causes scarring alopecia.
You may have heard wellness girlies talking about inflammation on your feed, and truly, it can affect everything from your gut to your hairline.
In this case, inflammation can damage healthy hair follicles. This can eventually lead to destroyed hair follicles and sebaceous glands, causing permanent hair loss.
What Does Scarring Alopecia Look Like?
Depending on the form of scarring alopecia you have, it may present itself in different forms. That said, most scarring alopecias share a few common features.
Symptoms of scarring alopecia can include:
Loss of sebaceous glands
Hair thinning
Naked hair shafts
Follicular or diffuse dermal scarring
Premature desquamation of the inner root sheath
With this in mind, symptoms and treatments vary from person to person.
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Diagnosis & Treatment for Scarring Alopecia
Scarring alopecia is fairly rare, so effective treatments and research for this type of hair loss are limited.
If you’re wondering if hair can grow on scars, the answer is typically no — unfortunately. Since hair follicles are usually destroyed and replaced with scar tissue, this type of damage is not reversible by current medical standards. The best “treatment” is early detection and minimization of the damage.
Treatments aren’t simple, though, thanks to the numerous potential underlying causes that can create inflammation and damage. With this in mind, a healthcare professional may prescribe one or several treatments to halt the progress of the disease.
Common treatments for scarring hair loss include:
Anti-inflammatory medications. These treatments can stop the inflammation and mitigate the damage. A pharmacist can help you avoid drug interactions if you’re taking multiple medications.
Corticosteroids. These steroids can be used to treat certain underlying conditions that may cause scarring hair loss.
Topical steroids. Topical steroids are sometimes used to treat conditions, like lichen planus and central centrifugal cicatricial alopecia (CCCA), which can be commonly seen in Black women.
Immunosuppressants. These medications can be used to mitigate damage in the case of an autoimmune cause.
Oral steroids. For primary cicatricial alopecia conditions, like lichen planopilaris and frontal fibrosing alopecia or chronic cutaneous lupus erythematosus, oral steroids have shown improvements in hair regrowth for issues like cellulitis of the scalp. These medications are sometimes used in combination with topical corticosteroid lotions and hydroxychloroquine.
Antiseptic shampoo. Conditions like folliculitis decalvans are typically treated with antiseptic shampoo, potentially combined with an antibiotic.
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No matter the treatment plan, the best place to start is somewhere. Early action is the best hair loss prevention.
Coping with Cicatricial Alopecia (Scarring Alopecia)
Hair loss can be tough, as hair often plays a big role in how you see yourself. If you think you’re dealing with scarring alopecia, it’s important to speak with a healthcare professional or dermatologist right away.
Your provider can conduct a biopsy to determine the root cause of your hair loss. Having an examination and getting a medical diagnosis can help determine the right course of action.
The psychological impact of hair loss shouldn’t be overlooked, so in the interim, it might be a good idea to speak with a mental health counselor. After all, hair loss doesn’t just affect your hairline — it can affect your self-esteem too.
If the idea of sitting on someone’s couch while spilling your feelings freaks you out, consider online therapy. You can get support right from the comfort of your own living room.
If you think you’re dealing with another type of hair loss, like androgenetic alopecia, certain hair loss treatments can help promote hair regrowth. Learn more about other types of hair loss and the available remedies in our comprehensive guide to male pattern baldness.
This article is for informational purposes only and does not constitute medical advice. The information contained herein is not a substitute for and should never be relied upon for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment or medication.