Scarring Alopecia; Causes and treatments

What is Scarring Alopecia (SA)?

Also called Cicatricial alopecia, is an inflammatory hair fall disease. This causes bald patches on the scalp that lead to permanent hair loss because the hair follicles are destroyed. The healthy scalp tissues are destroyed too and are replaced by fibrous tissue. Since the hair follicles are destroyed, hair cannot grow there again. Almost all cases of scarring alopecia start off as normal alopecia, but somewhere something goes wrong. This slowly progresses into irreversible or permanent baldness.

Symptoms of Scarring Alopecia

Scarring Alopecia starts off with few permanent bald patches on the head. The start small and eventually grows big in size and may even cover the whole head. Their appearance is shiny and smooth. There are no pores in the affected area because of loss of follicular opening.

Common symptoms of scarring alopecia include

  • Periodic Pain
  • Patches of scaly and rough skin
  • Blister Formation
  • Crusting of skin
  • Itchy scalp
  • Burning feeling on scalp
  • Pus and fluid discharge from the scalp (if infected)

Causes of Scarring Alopecia

The exact cause of scarring alopecia is still unknown. But the inflammation is considered as the major contributing factor. SA is caused by the permanent degeneration of hair follicles because of inflammation. Additionally, there is a loss of sebaceous glands and low collagen synthesis.

Slow cycling hair follicle stem cell (HFSC) destruction is also another reason for SA. Hair-care habits that include excessive use of hot combs, improper hygiene and excessive traction (hair pulling) can also be responsible for scarring alopecia specifically in women.

Other causes of SA are

  • Inflammation of hair follicles and skin
  • Factors like as tumors, injuries and burns
  • Genetic or Heredity
  • Destruction of hair follicle stem cells
  • Impairment in self-maintenance of HFSCs
  • Alteration in lipid metabolism

Diagnosis of Scarring Alopecia

After careful examination of the scalp, a skin sample is taken for further testing, this is called a biopsy. This has to be done by an expert dermatologist.

The doctors will take a look at your and your family’s medical history and check for possible links.  Some obvious signs like itching or burning of the scalp with pus and fluid discharge also help in diagnosis of scarring alopecia.

The age of the patient is an important indication factor. This helps determine what type of alopecia they are affected with. For example frontal fibrosing alopecia affects women going through menopause. But primary cicatricial alopecia develops in early adult life or even from the age of 16 or 17.

Closed or absent skin pores in the affected area are also an indicating sign. The doctor will perform a “hair pulling test” to determine the extent of damage. If the hair comes out easily then it means the test is positive. Meaning that SA is active and spreading quickly.

The diagnosis of SA is done on the base of

  • Common signs like itching, burning feeling or discharge of pus/fluid from scalp.
  • Absent or closed pores in the affected areas.
  • Hair pull test to see how deep the scarring has gone.
  • Scalp biopsy for skin sample examination
  • Scalp examination
  • Age of the patient and details of medical history
  • Before and after scalp conditions

Treatments of Scarring Alopecia

Treatment of scarring alopecia should be quite aggressive because it can lead to a lot damage or permanent hair loss. The nature of treatment varies depending on the particular diagnosis. Scarring alopecias that include for the most part lymphocyte inflammation of hair follicles, for example, lichen planopilaris and pseudopelade, are commonly treated with corticosteroids in topical creams and by infusion into the influenced skin. Likewise, antimalarial and isotretinoin medications might be utilized.

For scarring alopecias with inflammation of for the most part neutrophils or a blend of cells, the run of the mill treatment includes antibiotics and isotretinoin. All the more tentatively, drugs like methotrexate, tacrolimus, cyclosporin, and even thalidomide have been utilized to treat a few structures.

Once scarring alopecia reaches the burnt-out stage, bald areas can be either surgically removed if they are not too big or the bald patches can be transplanted with hair follicles taken from unaffected areas.


The problem with auto-immune diseases is that there is very little chance of finding out exactly what is causing the problem. This makes treatments a bit difficult. So for now the only options are condition suppressing medicines that stop the symptoms form surfacing as long as the medication continues.

If you notice abnormal hair loss or bald patches on your head, go see your doctor. The best way to prevent alopecia from spreading is to catch the problem as early as possible and start hair loss treatment. This will give you a head start and might even help stop the problem completely.