Scarring Alopecia

Scarring alopecia is caused by an inflammation of the scalp. This inflammation happens as a result of an infection and it is one of the main reasons for hair loss. Scarring alopecia can be treated if it’s diagnosed early.



It causes rough patches on the scalp made up of tiny blood vessels and connective tissue and has been the root of hair loss problem in most healthy men and women around the world.

Scarring alopecia has many different variations; the most common among them is destruction of hair follicles. The destroyed hair follicles are replaced with permanent scars. The first symptom of this disease is the occurrence of small patches on the head, which causes hair to decrease. These patches may grow gradually. Along with hair loss, itching, pain and burning are also causes by Scarring Alopecia and the condition keeps getting worse.

The patches that appear as a result of scarring alopecia appear differently from alopecia areata. These patches have ragged edges, apart from which you cannot notice the extent of actual damage that happens below the surface of the skin. The patches could either appear smooth and clean or have pigmentation, redness or blisters with fluid and pus coming out of the affected area.

The lack of visual conditions prevents this disease from being detected and diagnosed early. Since the patches on the skins do not tell much dermatologists usually suggest biopsy of the skin to be conducted to confirm the diagnosis if it is suspected. In the preliminary stage of the disease, hair follicles will have inflammatory cells surrounding it. These inflammatory cells cause the destruction of hair follicles eventually and the destroyed hair follicles are replaced by scar tissue. In some cases however, biopsy of the affected skin shows very little or no inflammation at all.

Scarring alopecia has a defined lifetime and in most cases it goes away at the end of it. The patches stop growing or increasing and the feelings of pain and itching disappear. The skin biopsy at this stage shows no inflammatory cells around the hair follicles and if scarring alopecia has not completely destroyed the hair follicle, it may re grow. Scars are left, however, deep inside the skin leaving a mark of the hair follicles that were damaged during the disease.

The various different types of scarring alopecia are: dissecting cellulitis, eosinophilic pustular folliculitis, follicular degeneration syndrome (previously called "hot comb" alopecia), folliculitis decalvans, lichen planopilaris, and pseudopelade of Brocq. This disease can also cause a chronic condition known as lupus erythematosus in which other parts of the human body could be affected.

Discoid Lupus Erythematosus
Discoid Lupus Erythematosus is a diffuse connective tissue disease, which causes hair loss on the scalp. Lesions occur around scaling papules 5 to 10 mm across with follicular plugging. It may not show scaling characteristics and the skin gradually turns smooth atrophic and scarred. Discoid Lupus Erythematosus is affected by light and therefore the patient should avoid exposing the skin to sunlight. Triamcinolone acetonide, which is a type of a topical corticosteroid ointment, may treat lesions. Hydroxychloroquine is also helpful in the treatment of Lupus.

Lichen Planus
It is a very rare form of scalp Alopecia and around 1% of the population of the world has been diagnosed with it. Lichen Planus causes inflammation on the skin and mucous membranes. It starts by itching on the wrists and forearms, legs, ankles and lower back. Another variation of this disease affects the scalp and other areas and it is known as Lichin Planopilaris. Raised reddish purple area appears on the scalp making it look like lichen on a rock. Lichen Planus can also be diagnosed if Alopecia appears on the scalp with follicle plugging. This however, goes away after some time. Steroid lotions help relieving itchiness and drugs used for malaria can reduce inflammation.

Pseudopelade of Brocq
Pseudopelade of Brocq is also a rare type of scarring alopecia, which is often found in middle-aged people. Hair follicles almost never re-grow after being affected.

Aplasia Cutis Congenita
Aplasia Cutis Congenita is another rare variation that affects a smaller area and usually causes blisters in the midline of the scalp. This disease goes away after a certain period of time but sometimes can cause other diseases and problems.

Congenital Atrichia
Congenital Atrichia affects newborn babies whose head are kept covered with a piece of cloth.
The treatment for scarring alopecia is very important as it can cause the permanent bald patches on the scalp. Different types of this disease are treated differently. Creams and corticosteroids can be used to treat different types of scarring alopecia, which cause inflammation of hair follicles. When scarring alopecia goes away, the bald patches can be removed by surgery and hair can be transplanted from infection free areas of the body.