Experiencing hair loss can be unsettling for anyone but especially when its progressively getting worse. Whilst most people have heard of pattern hair loss, there’s less talk about scarring alopecia which permanently damages hair follicles. This can lead to irreversible baldness and hence early diagnosis is vital. In this article, we’ll explore what scarring alopecia is, its underlying causes and if it can be stopped. We’ll also review the best treatment options to manage or help reverse hair loss in scarring alopecia.
What is Scarring Alopecia?
Scarring alopecia, also known as cicatricial alopecia, is a group of hair loss disorders that permanently damage hair follicles. They replace these follicles with scar tissue. Unlike other forms of hair loss like early androgenetic or traction alopecia, this condition is irreversible once there is follicle destruction. Although scarring alopecia can affect people of all genders, ages and ethnic backgrounds some people or more likely to get certain types. For example, Central Centrifugal Cicatricial Alopecia is more likely to affect women of African descent. Overall, scarring alopecia is not common and only affects 7% of people with hair loss but its impact can be severe. This is why early diagnosis and treatment are crucial in order to managing symptoms and preventing progression.
How Does Scarring Alopecia Start?
In general, scarring alopecia starts with inflammation which then targets and destroys the hair follicles. At the beginning, you may notice scalp symptoms such as:
- Itching
- Redness
- Small patches of hair loss or changes in skin texture
As you can see these symptoms are a bit vague and you can easily mistake them with scalp conditions like seborrheic dermatitis, eczema or psoriasis. Its important not to ignore any symptoms of scalp irritation as early diagnosis of scarring alopecia is critical to prevent further permanent hair loss.
Is Scarring Alopecia an Autoimmune Disease?
As we discussed earlier, scarring alopecia is actually a collection of different scalp conditions that cause permanent damage to the hair loss. As such these conditions have different causes. Many forms of scarring alopecia, such as lichen planopilaris and frontal fibrosing alopecia, are due to autoimmune disease. In these cases, the body’s immune system mistakenly attacks the hair follicles. This causes chronic inflammation and subsequent scarring. However, autoimmune reactions are not the only cause. Other causes of scarring alopecia include genetic predisposition, environmental triggers (such as chemical treatments, heat damage, infections, trauma and prolonged mechanical stress.
Types of Scarring Alopecia
There are many different types of scarring alopecia and these are often divided into primary and secondary conditions. Primary forms are due to inflammation directly targeting the hair follicles. Secondary conditions are due to environmental injury to the scalp which then results in hair follicle damage. The main types of scarring alopecia include:
- Central Centrifugal Cicatricial Alopecia (CCCA): CCCA usually begins at the crown or centre of the scalp before gradually spreading outward. It seems to have a genetic predisposition but has some common triggers like tight hairstyles, chemical relaxers and heat styling.
- Lichen Planopilaris: This presents as patchy hair loss accompanied by redness and scaling. It is usually due to autoimmune disease and can cause discomfort through itching or pain.
- Frontal Fibrosing Alopecia: This type of scarring alopecia mainly affects post-menopausal women. There is usually an association with hormonal changes and autoimmune factors. Frontal fibrosing alopecia usually causes hair loss along the front hairline and eyebrows.
- Discoid Lupus Erythematosus (DLE): DLE is closely linked with lupus which is an autoimmune condition. It usually presents as disc-shaped lesions on the scalp which cause permanent scarring and hair loss. Symptoms can get worse due to sun exposure.
- Secondary Scarring Alopecia: These can arise from scalp damage due to external factors like fungal or bacterial infections, physical injuries, burns, radiation therapy or chronic conditions such as severe psoriasis or folliculitis. This then results in follicle damage as a side effect of the scar tissue caused by these diseases.
Diagnosis
Due to the seriousness of this condition, early and accurate diagnosis is necessary. This needs a detailed clinical evaluation by a dermatologist or trichologist. As part of the process your healthcare provider may:
- Conduct a thorough scalp examination to identify signs of inflammation, scarring or follicle damage.
- Take a detailed medical history, including hair-care practices and family history of hair loss.
- Perform a scalp biopsy. This is where a small piece of scalp tissue is examined under a microscope to confirm the diagnosis and identify the specific type of scarring alopecia.
- Recommend blood tests to identify or rule out underlying conditions such as autoimmune disorders or hormonal imbalances.
How to Treat Scarring Alopecia
Treating scarring alopecia typically involves a multi-pronged approach which aims to stop inflammation and disease progression. Although you can not reverse hair follicle damage due to scarring alopecia once, early and aggressive treatment ensure further hair loss is stopped. Below are the main treatment options for scarring alopecia:
- Medical Treatments: This depends on the underlying cause. Your treating provider may recommend topical steroids like hydrocortisone or clobetasone as first line. They may also consider other immunosuppressants, oral medications such as doxycycline or hydroxychloroquine or intralesional steroid injections for severe or refractive cases. Minoxidil and metformin may also be useful adjuncts to promote hair growth.
- Lifestyle & Scalp Care: Effective scalp care includes avoiding tight hairstyles, limiting chemical treatments or heat styling as well as adopting gentle hair care practices. Additionally, protecting your scalp from sun exposure can also help reduce triggering factors.
- Surgical & Cosmetic Solutions: In advanced cases of scarring alopecia, hair transplantation may be helpful but only if the underlying inflammation has stopped. In the meantime, wigs, hairpieces, hair fibres or scalp micropigmentation may help from a cosmetic perspective to help improve confidence.
Can Scarring Alopecia Be Stopped or Prevented?
Although scarring alopecia itself cannot be reversed once hair follicles are damaged, proactive steps can significantly slow its progression and reduce further loss. Prevention is possible especially in cases of secondary scarring whereby avoiding certain environmental and lifestyle factors can reduce the risk of developing it. The key is early detection and treatment. If you notice sudden or patchy hair loss, persistent scalp discomfort or scalp texture changes then you should seek immediate medical help. This is your strongest tool to reverse progression of scarring alopecia.
Although scarring alopecia is a serious condition that can cause permanent hair follicle damage, its important not to despair. Getting medical help and early diagnosis will increase you chances of effective treatment depending on the type. This is often a chronic condition so you will need regular medical check-ups and adopt lifestyle measures to protect your scalp.
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