TL;DR:
- Scarring alopecia is a chronic, irreversible form of hair loss caused by scarring and fibrous tissue replacing hair follicles.
- Affects ~7% of patients, mainly women aged 30-50, commonly in the frontal and temporal areas.
- Symptoms: Hair loss with shiny, scarred skin; early signs include scalp pain, itching, and loss of self-confidence.
- Causes:
- Genetic disorders (e.g., follicular keratosis, congenital conditions).
- External factors (mechanical, thermal, chemical damage, UV exposure).
- Autoimmune diseases, infections, and cancers.
- Types: Primary (genetic), Secondary (external causes).
- Diagnosis: Requires trichoscopy and often scalp biopsy.
- Treatment: Early diagnosis critical; anti-inflammatory medications (topical/oral) help stop progression.
- While incurable, therapy stabilizes the condition and prevents further damage.
- Cancer-related alopecia requires biopsy to confirm or rule out metastases.
As a form of hair loss, scarring alopecia is quite a troublesome problem. In addition, this condition is accompanied by the formation of scars in the hair follicles, which in turn can cause a lot of complexes. This type of alopecia affects a fairly small group of patients (7%), but once it occurs, it can be very difficult to reduce on its own.
What is scarring alopecia?
Scarring alopecia results in hair loss associated with the process of hair loss with overgrowth of the hair follicle with fibrous tissue and collagen, which is irreversible. A distinct scar is formed on the skin. Baldness of this type occurs mainly in the frontal and temporal arch area, although it can also appear elsewhere on the scalp and face – eyelashes and eyebrows, as well as under the armpits. Skin lesions outside the frontotemporal arch are quite rare. However, it is worth remembering that once they appear, the course of the condition can progress much faster. The sooner a patient goes to a specialist, the sooner the appropriate treatment will be implemented, which can effectively cure the disease and stop its spread.
Scarring alopecia – what are the symptoms?
Scarring alopecia mainly affects women between the ages of 30 and 50. There are usually no subjective symptoms. The lesions spread at a slow pace, and the skin surface in the area gains a sheen, with no visible hair or inflammatory features. Single tufts of hair can be observed on the scalp or face, which are arranged in a so-called brush pattern. In the initial stage of alopecia, the symptoms are not specific – they occur in the form of pain in the scalp, accompanied by itching and hair loss. Due to excessive hair loss (and therefore aesthetic issues), the patient may also experience psychological discomfort and even fall into depression. Patients lose self-confidence as a result of hair loss.
What are the causes of scarring alopecia?
Scarring alopecia is often a consequence of other conditions that run in the scalp area, including follicular lichen planus, focal lupus erythematosus, scarring folliculitis, or stratified dermatitis scalp. The consequence of inflammation in the hair and sebaceous parts is scarring of the hair follicles, which are then replaced by fibrous tissue. Such a phenomenon is irreversible, because once the scarring of hair follicles occurs, the hair in them cannot be regrown. This is why it is so important for the patient to react early, and for the doctor to make the correct diagnosis to include the appropriate therapy. The reasons for scarring alopecia can also be divided into:
- Genetic disorders, among which are:
- Follicular keratosis alopecia,
- Fish scale,
- Dye incontinence,
- Darier's disease,
- Congenital skin underdevelopment,
- Bullous epidermal separation.
- External physical factors, which include:
- Mechanical damage,
- Thermal damage,
- Chemical damage,
- UV radiation,
- Poor hygiene.
- Cancers,
- Infectious diseases,
- Autoimmune diseases.
What are the types of scarring alopecia?
Scarring alopecia is divided into two basic types:
- Primary, which is due to genetic factors, including autoimmune diseases. An autoimmune disease is nothing more than a condition in which the immune system attacks its own body. It simultaneously sends antibodies against itself. During the primary version of this condition, a specific inflammation is created irreversibly destroying the hair follicles.
- Secondary, which is caused by external factors, infections and can occur with other diseases attacking the body. During this condition, the hair follicles are damaged, which is a side effect of conditions taking place in the body.
What is the diagnosis based on?
Diagnosis in scarring alopecia requires trichoscopic examination, through which the doctor can verify what disease entity the alopecia is associated with. Very often, when scarring alopecia is suspected, the specialist orders a biopsy of the scalp to confirm the trouble and allow the introduction of appropriately targeted treatment.
How to treat scarring alopecia?
Treatment is carried out by dermatologists trichologists. Of great importance for the success of therapy is the diagnosis in the early stages of alopecia. This can stop the process of scarring of hair follicles and prevent permanent hair loss. Therapy consists of applying anti-inflammatory drugs topically to the balding scalp, as well as giving the patient oral medications.
Scarring treatment – who can help?
First of all, a trichologist can help in the treatment of this condition. The specialist performs the necessary diagnosis of the type of baldness and implements drug treatment. A cosmetic trichologist, in turn, can perform non-invasive treatments that support drug treatment. A surgeon, on the other hand, is a specialist who performs a scalp biopsy, which is a common part of diagnosing the underlying cause of baldness.
Can scarring alopecia be completely cured?
Scarring alopecia is distinguished by its chronic nature and often autoimmune process, which is why it is an incurable condition. However, thanks to pharmacotherapy and surgery, its process can be effectively stopped and the seemingly irreversible changes can undergo regeneration.
Can the risk of contracting the disease be reduced?
Due to the mechanism of scarring alopecia, it is difficult to prevent the disease or reduce its unpleasant effects. However, it should be borne in mind that the hairy scalp is a common location for cancer metastasis. Cancer cells can damage hair follicles and cause baldness. Therefore, any outbreak of baldness should be verified with a biopsy to rule out this possibility.
Conclusion
Scarring alopecia is a tough challenge due to its permanent hair loss and scarring. Early diagnosis and intervention are critical to slowing its progression and managing symptoms. While it cannot be completely cured, treatments from skilled trichologists and dermatologists offer hope in stopping further damage. Whether caused by genetics, autoimmune issues, or external factors, timely action and professional care make a big difference. Understanding the condition, seeking help early, and following proper treatment can help preserve both your hair and confidence.
