Scarring Alopecia - Causes, Treatments & Symptoms

What Is Scarring Alopecia And How To Treat It?

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Scarring Alopecia is a group of hair loss condition, that can lead to permanent balding. Also known as cicatricial alopecia, it is a rare condition that is experienced by almost 3% of people suffering from hair loss. Both men and women can suffer from scarring hair loss, irrespective of their background or genetics. It is a dreadful condition, thus early detection and dedicated care must be administered.

What Are The Different Types Of Scarring Alopecia?

Scarring alopecia depicts several hair loss conditions that can be of different types. It is classified into 3 types

  • Primary scarring alopecia – Here the hair follicle is damaged and replaced by the fibrous tissue. Thus the stem cells in hair root are destroyed. The follicle is the main target which is the originating point of the disease. These can further be grouped into 3 categories; lymphocytic, neutrophilic and mixed cicatricial alopecia. These further include frontal fibrosing alopecia (FFA), lichen planopilaris (LPP), central centrifugal alopecia (CCCA), pseudopelade and folliculitis decalvans (FD).
  • Secondary scarring alopecia – Here the hair follicles are damaged due to inflammation of the skin. This is also an irreversible damage, caused due to destruction of hair follicles due to burns, cancer therapy and trauma.
  • Developmental or hereditary alopecia – These are caused due to genetics or hormonal imbalances. They may also be caused due to male and female pattern baldness.It doesn’t matter what kind of cicatricial alopecia one might have – all these conditions end up developing in a similar manner. They destroy the hair follicles to a great extent, resulting in permanent baldness. This is because scar tissues end up replacing the healthy hair follicles. While scarring alopecia can develop as male or female pattern baldness, its treatment is mostly personalized depending on the type of disorder.

Also Read: Hair Loss – Common Symptoms, Classifications & Medical Solutions

What Are The Signs & Symptoms Of Scarring Alopecia?

Since scarring alopecia can result in permanent hair damage, it is recommended to identify at an early stage. Ideally, you should look for the following signs to identify this conditions as early as possible.
• Itching, burning, pain and tenderness of the scalp
• Inflammation of the scalp and hair follicles
• Thinning of hair strands
• Formation of scales on the scalp
• Raised blisters (can also have pus formation)
• Redness or decreased pigmentation on the scalp
• Crusting
It is not necessary that cicatricial alopecia will leave a “scar” on the scalp. Sometimes, it can also make your scalp smooth after damaging the follicles permanently. Also, some scarring hair loss conditions might not depict any kind of symptom at all. The best way to identify it is by getting a thorough scalp check. Even if you are facing a few of these symptoms, visit a dermatologist to avoid the end stage of scarring alopecia.

What Are The Causes Of Scarring Alopecia?

The exact causes of scarring alopecia are still not known. It has been observed that almost all the cicatricial alopecia conditions target the sebaceous gland and stem cells in the hair follicles. Due to this, it often leads to the permanent loss of hair. It has been observed that the cicatricial alopecia causes are majorly not linked to genetics. Unlike non scarring alopecia, it is possible to suffer from more than one kind of scarring hair loss at a time. Even though scarring alopecia is seen in both men and women, it is not contagious in nature. Some probable causes of scarring alopecia include –
• Destruction of hair follicle stem cells
• Inflammations due to injuries, tumours or burn
• Some specific genetic factors like in CCCA, affecting several women of African ancestry of the same family
• Altered lipid metabolism

Also Read: How To Find The Best Dermatologist For Hair Loss?

How To Treat Scarring Alopecia?

The end stage of scarring alopecia is often marked as an irreversible condition. Though, you can get a scarring alopecia treatment at an early stage to prevent it from spreading and heal the nearby areas.
• Oral and topical medicines – Doctors usually start the cicatricle alopecia treatment with various oral and topical medicines. There are certain serums and shampoos that you can use to heal your scalp. These medicines have anti-inflammatory agents that heal the follicles. Minoxidil can be used to stimulate any small unscarred hair follicle remaining on the scalp, to restore hair re-growth. Besides topical serums, there are a few oral medicines as well that can improve the quality of your scalp by strengthening the blood vessels underneath.

• Hair restoration surgery – Since cicatricial alopecia is a severe condition, it demands more dedicated solutions. Most of the patients undergo a hair restoration surgery. It is an invasive approach, in which hair strands are removed from a donor site and are planted on the affected area. Usually, FUE (Follicular Unit Extraction) harvesting is recommended to treat scarring hair loss. In this, follicle units (having 3-4 hair strands) are removed from the donor site. They are grafted on the bald patches to make the hair look more natural. Strip harvesting and follicular unit transplant are some other surgical approaches that you can explore.

• Scalp reduction – Scalp reduction is another invasive approach that can be implemented as a scarring alopecia treatment. In this, the infected part of the scalp is removed and the adjacent skin is pulled (and stitched) together. For instance, if you are suffering from scarring hair loss at the top of your scalp, then the skin would be pulled from the sides and stitched. Though, just like other surgical approaches, this one also has a few side effects and can even develop minute scars in the end. There are a few other scalp reconstruction procedures that can treat cicatricial alopecia to a great extent.

Also Read: What Is Androgenetic Alopecia & How To Cure It?

What Is “Refractory” Scarring Alopecia?

When the scarring hair loss reaches a more progressive stage and becomes unmanageable, it is known as “refractory” scarring alopecia. It mostly happens when the hair follicles are shrunk and suffer from the lack of nutrition. In this situation, our scalp does not react to any topical or oral medicine. Since traditional hair regrowth methods fail to manage such a progressive cicatricial alopecia, a specialized approach is mostly followed to treat it.

PRP For Refractory Scarring (Cicatricial) Alopecia

PRP treatment for refractory scarring hair loss is mostly recommended if its last stage has not been reached. PRP or platelet-rich plasma therapy is non-invasive technique for hair regrowth. As the name suggests, platelet-rich plasma is developed by extracting the patient’s own blood through centrifugal process. The activated plasma is then injected into the upper layer of the scalp using a micro-needle. It nourishes the follicles and preserves the remaining hair thus causing hair regrowth and restoration, naturally. Additionally, oral and topical medications must also be prescribed by your dermatologist to enrich the treatment.
If the follicles have not been replaced by the scarring tissues, then they can grow again. Though, the PRP treatment is not recommended for every patient with scarring alopecia. Therefore, you should get a comprehensive scalp examination done by a dermatologist to know if you would be benefited by the PRP treatment or not.

Also Read: What Is PRP Hair Treatment & How Much It Cost?


Can hair grow back from scarring alopecia?
It depends on the degree of scarring hair loss. At the end stage of scarring alopecia, follicles are entirely replaced by scarred tissues. In this case, a surgical approach (like scalp reconstruction) is followed. If the follicles are still viable, then PRP can be opted as a scarring alopecia treatment.

Is scarring and cicatricial alopecia same?
Cicatricial alopecia is a medical term for a group of conditions that damage our hair follicles. Since it replaces the healthy follicles with scar tissues, the condition is often known as scarring hair loss. Though, both of them depict the same hair loss condition.

What stage scarring alopecia can be treated with PRP?
PRP treatment for scarring alopecia is recommended at an early-to-medium stage when the hair follicles are not entirely damaged. The condition is known as refractory scarring hair loss, as traditional treatments fail to provide productive results. At a more progressive stage, scarring alopecia hair transplant is performed.

If you think you are experiencing the early symptoms of scarring alopecia, then visit an experienced dermatologist right away. Dedicated and timely treatment must be administered to prevent it from causing any permanent damage to your hair.

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About The Author

Kushneet Kukreja

Kushneet Kukreja

A postgraduate in Biotechnology from Kingston University and an ISSA Certified Specialist in Fitness & Nutrition, Kushneet Kukreja is a passionate writer who works in close association with the dermatologists at our head office to generate valuable and scientifically accurate content for our blog.

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