Scarring Alopecia: Meaning, Symptoms and Treatment

Did you know that hair loss impacts an estimated 80 million Americans?

However, not all hair loss is the same, as different kinds exist. For instance, scarring alopecia is less common and affects about 3% of the population. 

Also known as cicatricial alopecia (CA) or scarring hair loss, scarring alopecia refers to a group of hair loss disorders. CA is divided into primary and secondary groups.  

Primary and secondary cicatricial alopecias

In an article for Vegamour, Dr. Jules Annen, trichologist & Ph.D., notes that both primary and secondary CA involve inflammation that harms hair follicles, causing irreversible hair loss. 

According to the National Organization for Rare Disorders (NORD):

1. Primary CA occurs when hair follicles are harmed and replaced by fibrous tissue (scar tissue). Consequently, the stem cells in the hair’s root are destroyed. 

Also worth noting, the follicles are the originating point of the disorder.

Commonly recognized forms of primary CA include: 

• CCCA alopecia (central centrifugal alopecia) 
• LPP (lichen planopilaris) 
• FFA (frontal fibrosing alopecia) 
• FD (folliculitis decalvans) 

2. Secondary CA occurs when physical factors, such as severe infections, tumors, or burns, harm the hair follicles. Therefore, in this case, the follicle is an innocent bystander hurt by outside forces.

In short, primary CA happens when the hair follicles are destroyed due to a follicular disorder. Secondary CA happens when an external factor provokes follicular scarring.

The most typical theme among all types of scarring hair loss is the destruction of hair follicles, which are replaced by scar tissue, preventing hair regrowth. 

What causes scarring hair loss?

The culprit behind scarring hair loss isn’t yet fully understood. 

Nevertheless, all kinds of CA involve inflammation in the upper part of the hair follicle, where the oil gland and stem cells are. 

If the oil gland and stem cells are destroyed, there’s no chance for hair regeneration, making the balding permanent. 

Interestingly enough, cicatricial alopecias aren’t contagious. 

Finally, according to a medically written and reviewed article in Oliva, some likely causes of CA, include:

• Destruction of hair follicle stem cells
• Inflammation due to burns, injuries, or tumors
• Distinct genetic factors for CCCA 

How can you know if you have scarring hair loss? First, you must ask, “What does scarring alopecia look like?”

What does scarring alopecia look like?

Inflammation happens below the skin’s surface. Therefore, scarring usually can’t be seen on the scalp, but the affected area is commonly left smooth and bare (without hair or pore markings).

Symptoms can range depending on the type of scarring hair loss a person has.

Some common symptoms can occur, such as:

• Severe itchiness 
• Pain or discomfort at the site of hair loss
• Burning 
• Shedding of hair in clumps
• Scalp inflammation and sensitivity
• Pus discharge
• Blisters 
• Crusting over the skin or scalp
• Redness
• Scales

What does scarring alopecia look like in the beginning stages? 

CA usually first appears as little patches of balding that can increase in size. Sometimes, hair loss is gradual and may go undetected for a long time. 

In other cases, hair loss is rapid and goes hand-in-hand with intense burning, itching, and pain.

Because the war on the follicles is underneath the skin, you might only see a patch of baldness.  

Scalp areas that CA has impacted can be clean and smooth, or they may be red with blisters and pus. 

Risk factors

Scarring hair loss affects all genders and ages, although primary CA is unusual in children. This condition occurs worldwide, but in general, they aren’t common.

Moreover, CCCA alopecia (central centrifugal alopecia) most typically impacts middle-aged women of African ancestry. Nevertheless, CCCA alopecia can be seen in males and individuals of all races and hair colors, although seldomly. 

Regardless, most people with scarring hair loss don’t have a family history, so genetics aren’t necessarily at play. 

Central centrifugal alopecia (CCCA) versus traction alopecia (TA)

According to the American Academy of Dermatology Association, CCCA is the most common kind of scarring hair loss among females of African descent.

It can seem similar to traction alopecia, but the two conditions aren’t the same and look different under a microscope. 

People with CCCA may never have worn their hair in tight styles, but it still develops. 

Whereas traction alopecia scarring occurs after one’s hair is continually pulled or undergoes consistent tension. 

Hairstyles, such as tight braids, buns, and ponytails, can hurt hair follicles, causing them to eventually scar, so no new hair emerges. 

Fmen

Wearing looser hairstyles and avoiding harsh styling chemicals can prevent traction alopecia scarring from further developing.

Symptoms of traction alopecia can include redness, soreness, and itching.

Furthermore, you’ll want to be examined by an experienced dermatologist to determine if you’re experiencing CCCA or traction alopecia scarring. 

A visit to your MD is best booked sooner than later! 

Diagnosis

Before determining scarring alopecia treatment, it needs to be diagnosed. 

Firstly, the physician will get a thorough medical history from the patient. Secondly, the individual will likely need a scalp biopsy to understand what’s causing the condition. 

The biopsy helps the doctor learn the type of inflammation to determine the appropriate treatment. 

According to Mount Sinai Health System, A hair-pull test supports diagnosis and guides the physician on where to biopsy. 

In a pull test, the MD will grab a section of hair in an affected area. The pull test results are based on the number of hairs removed after pulling.

Five or more released hairs indicate inflammation is destructive, and follicles are becoming loosened from their surrounding tissue. 

Scarring alopecia treatment

In an interview for Skin Alliance, American Board of Dermatology Certified, Dr. Jerry Shapiro reveals: 

“Patients must be treated once the diagnosis is made, and they must be treated quickly, because every hair they lose is gone.” 

Shapiro classifies CA as a trichologic emergency because the condition will advance to permanent hair loss if management is delayed.

“The main thing is to preserve and rescue the hair follicle,” explains Shapiro

Each treatment depends on an individual’s scarring hair loss and what their doctor prescribes. 

Shapiro clarifies that he considers the following factors before determining treatment:

• Age of patient
• Extent of CA
• Type of CA

Scarring alopecia treatment can include: 

• Oral and topical medication
• Hair restoration surgery
• Scalp reduction

Is hair regrowth possible?

Scarring alopecia regrowth isn’t possible once follicles have been destroyed. 

On a positive note, a physician can treat inflammation successfully before too many follicles are decimated. 

For this reason, time is of the essence. Seeking diagnosis and treatment as early as possible is your best shot at controlling inflammation to prevent further balding. 

Furthermore, often, there’s enough hair to cover an individual’s scalp in bald areas. Wigs and hats are also useful options that don’t provoke or complicate the condition. 

Dr. Shapiro explains that scarring alopecia regrowth can sometimes occur if the condition is caught extremely early. However, this hair growth isn’t common and shouldn’t be relied upon or seen as the norm. 

What should I do if I’m worried about hair loss?

If you’re experiencing hair loss or scalp irritation, no matter how mild, seek medical care immediately. Several possible factors could be causing it, and it’s better to be safe than sorry.

We recommend contacting one of our licensed Ravkoo Doctors to book a remote consultation asap. 

To get started:

1. Download the Ravkoo Health app, available for iOS and Android.
2. Access Ravkoo MD from within the app to select a healthcare provider. 
3. Book an appointment with your doctor.
4. Attend your consultation from the privacy of your home. 

Hair loss of any kind can be uncomfortable, and it can cause social anxiety or feelings of embarrassment. 

Rest assured, you don’t have to go through it alone. Our caring and professional team of doctors at Ravkoo Health are here to help. 

Final thoughts

CA can be very challenging emotionally, and seeking resources for support, such as counseling or a psychiatrist, while undergoing medical treatment is crucial.

Also, the length of treatment and corresponding results vary from person to person. 

There are numerous ways to manage hair loss, including medications, shampoos, creams, or surgical procedures. 

Finally, hair loss can be progressive, so you must see a provider and address your symptoms when you first notice them.