Scarring alopecia, also known as cicatricial alopecia, is a condition where there is potential permanent and irreversible destruction of hair follicles which leads to their replacement with scar tissue. It is a very rare form of alopecia and only occurs among 3% of healthy men and women across all ages.
Most forms of hair loss scarring alopecia start as small patches of hair loss that expand over a period of time. In a lot of cases, the hair loss is gradual and without any noticeable symptoms. It also goes unnoticed for a long period of time. However, in some instances, it is associated with severe itching, burning, and progresses very quickly.
When cicatricial alopecia is suspected, skin biopsies are done to identify the particular type of alopecia. A 2-4 millimeter biopsy is taken and examined by the dermatopathologists in the laboratory under laboratoryunder the microscope. In the early stages, inflammatory cells will be present around the hair follicles which induces the destruction of scar tissue. After a while, the bald patches stop expanding and all the pain goes away. In the final stage, a biopsy will no longer show any inflammation and only a few longitudinal scars will be left to show where the hair follicles were present.
What causes scarring alopecia? The scarring alopecia causes are not yet completely known or understood. However, all forms of cicatricial alopecia involve inflammation at the upper part of the hair follicle. This is where the stem cells and the sebaceous glands are located. In cicatricial alopecia, these stem cells and sebaceous glands are destroyed leading to no possibility of regeneration of the hair follicle. Therefore, there is permanent hair loss. The good part is that cicatricial alopecia is not contagious.
Scarring alopecia treatment options are limited. The nature of scarring alopecia treatment depends on the diagnosis and the progressiveness of diease. The ones that have lymphocyte inflammation, such as lichen planopilaris, are treated with corticosteroids in the form of creams or injections. Antimalarial and isotretinoin drugs are also used in some cases. In the case of neutrophils, antibiotics and isotretinoin are used and experimental drugs like cyclosporine and tacrolimus have also been used.
The condition first appears as small patches of hair loss, and it can expand with time. The hair loss is gradual and can go on without any noticeable symptoms for a long time.
However, hair loss is associated with burning and severe itching sensations and pain that intensifies with time.
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No. You can only grow back the lost hair through surgical methods like transplantation. Hair transplantation remains the only way to significantly restore the hair in the areas affected by cicatricial alopecia. Consult a dermatologist to understand the severity and progression of your scarring alopecia and know if hair transplant is the right choice for you.
Most of the time, you won't be able to realize as the process of scarring alopecia is gradual. But if you are having symptoms like itching, burning, pus of purulent discharge from scalp, pain, patches of rough and dry skin, blisters, and crusting, it is advised to get a skin biopsy done to understand the alopecia.
The inflammation that leads to scarring alopecia happens underneath the skin and you cannot see any scar on the surface. Examination of the scalp will not show any broken hair shafts. Affected areas of the scalp can show signs of redness, scaling, pigmentation, pustules, and draining sinuses as signs of inflammation.
No. The treatment options are limited in the case of scarring alopecia and they are very aggressive in nature. Do not try to treat it at home; you may end up with a harsh reaction. Consult a doctor if you want to start treatment at the earliest.
There is no fixed timeline for the spread of cicatricial alopecia. In some cases, it spreads very slowly and is completely unnoticeable. However, in other instances, the rapid progression occurs along with severe symptoms like scaling, redness, pigmentation, blisters, and pustules.