Experiencing hair loss is a scary thing, no matter the severity. With so many hair loss types, there is one specific type of alopecia that is trickier to treat – scarring alopecia.

While it is less common than hair loss types such as androgenetic alopecia, scarring alopecia is a progressive condition that can lead to irreversible hair loss. Hence, it is important to get diagnosed and treated as soon as possible.

Also known as cicatricial alopecia, scarring alopecia is a catch-all term for a number of conditions that is characterized by inflammation of the scalp. Scarring alopecia can be further divided into two groups: primary cicatricial alopecia or secondary cicatricial alopecia – the former directly damages the hair follicles while the latter is usually a side effect of an illness or burns.

While scarring alopecia is considered rare (being diagnosed in up to 3% of hair loss patients), it can occur in otherwise healthy men and women.

Common types of scarring alopecias  

As mentioned earlier, scarring alopecia is the inflammation of the scalp caused by factors like excessive heat and chemicals found in hair products, fungal infections, or autoimmune disorders. The inflammation, in turn, destroys hair follicles, stem cells and the sebaceous glands below the surface of the scalp. Because of the destruction of hair follicles that is replaced with scarring tissue, this is what eventually leads to permanent hair loss.

While those with androgenetic alopecia lose hair strands predictably and gradually, scarring alopecia manifests in an unusual pattern and rapidly at an early stage.

The most common signs of those suffering from scarring alopecia are patches of hair loss which slowly expand over time, itching, burning, pain and tenderness of the scalp, and thinning of hair strands.

Some of the most common types of scarring alopecia include:

• Folliculitis decalvans

Folliculitis decalvans is a cross between alopecia and folliculitis – which describes the inflammation of hair follicles. While its precise cause is unknown, it is associated with the presence of a bacterial or fungal infection that causes small red bumps or pustules on the scalp; causing hair follicles to be destroyed and replaced with scar tissue. This type of hair loss can not only affect the scalp but also the beard, underarm hair, legs and arms. Symptoms include round or oval patches of hair loss, bald patches surrounded by pustules and scalp that is “tufted” (several hairs coming out of a single follicle).

• Lichen planopilaris

Lichen planopilaris may mimic other autoimmune forms of scarring alopecia and most commonly appears on the sides, front and lower back of the scalp. This type of scarring alopecia occurs more frequently in middle-aged women. The condition causes smooth, shiny patches of scalp, and at the edges of these patches, there may be scaliness and redness around the base of each hair.

• Frontal Fibrosing Alopecia

This condition is more common in young and middle-aged women over the age of 50. A patterned form of scarring alopecia that occurs along the frontal hairline and progresses, usually in a band-like fashion, towards the back of the head, it is often associated with regular sunscreen use, contact allergy to fragrances or autoimmune diseases including lupus erythematosus.

Unfortunately, there is currently no fool-proof cure for treating scarring alopecia. While the progression can be stopped, the hair that you have already lost will not grow back.

Is there no hope of treating scarring alopecia?

The good news is: it is still possible to don a good bed of hair even for people with scarring alopecia. The first order of business in treating the condition is to treat the primary inflammatory disease. Once the underlying cause of the hair loss is addressed, a dermatologist can then attempt to regrow hairs on the affected areas.

The first line of treatment for scarring alopecia is to treat it with anti-inflammatory medications. The goal is to destroy the inflammatory cells that are attacking and destroying the hair follicles and include medications such as doxycycline, cyclosporine and corticosteroids. Hair that has not been lost or destroyed can also be treated with minoxidil and antihistamines can be prescribed to relieve itching.

Corticosteroids can also come in the form of injections and should only be performed by a competent dermatologist. Antibiotics may also be recommended to help suppress the immune system in the case of lichen planopilaris. Each medication does come with side effects, so it’s always wise to get evaluated by a doctor with a special interest and experience in handling scalp and hair disorders.

Another promising solution for people with scarring alopecia is a hair transplant, in which a large number of follicular groupings can be transplanted into the affected scar tissues. The only caveat; however, is that the inflammation needs to be well-controlled and hair loss progression should be slowed (inactive for one to two years) to preserve as many viable follicles.

Since performing a hair transplant in scarred areas is much more complicated than doing so in a healthy scalp, many adjustments need to be accounted for to improve the survival rate of your hair follicles and optimize your results.

A 2013 study of 25 cases of hair transplants on scars saw 75% or more hair growth in the majority of patients at the 6-month follow-up appointment¹. However, they do recommend secondary or other treatments for more aesthetically-pleasing results. It is important to work with a hair transplant clinic that follows an individualized approach depending on the severity of your hair loss, the flexibility of your scalp and the shape of your head.

Stop feeling embarrassed about hair loss

Remember that even difficult-to-treat scarring alopecia is highly treatable with early intervention. Since the condition can be difficult to detect and symptoms vary between individuals – at the core of your hair loss treatment is to get an accurate diagnosis of your hair loss and its underlying cause from a professional and knowledgeable doctor.

Dr Angeline is a dermatologist in Singapore who can accurately diagnose your hair loss type with the help of visual examinations and perform a skin biopsy to look for the presence and location of inflammation in the hair follicles. While a hair transplant isn’t typically the first line of therapy for those with scarring alopecia,  Dr Angeline can provide an in-depth analysis of your scalp condition and to evaluate thoroughly if surgical hair restoration is suitable in your case.

As a well-trained dermatologist who is equipped in the management of medical hair loss conditions and subspecialty interests include hair disorders and hair transplantation, she can perform a range of hair loss treatments such as administering intralesional steroid injections and performing the FUT and FUE hair transplant. Contact us to learn more about our FUE hair transplant prices and arrange a consultation today.

References

Jung S, Oh SJ, Hoon Koh S. Hair follicle transplantation on scar tissue. J Craniofac Surg. 2013 Jul;24(4):1239-41. doi: 10.1097/SCS.0b013e31828a78ad. PMID: 23851778.