Scarring Alopecia

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Unlike other forms of hair loss, Scarring Alopecia does not refer to a singular and specific disorder but rather a diverse group of hair loss disorders that result in permanent hair loss in which the hair follicles have been completely destroyed.  It is often difficult to distinguish between them unless a small section of scalp is biopsied and microscopically examined by a dermatologist or pathologist.  A definitive diagnosis is possible by examining deep scar tissue to determine whether or not there is any inflammation present and where it is located relative to the hair follicles.  There are some ‘clues’ that might come in handy when making a diagnosis, however.

Visual and Physical Characteristics

Although Scarring Alopecia often presents itself in much the same way as Alopecia Areata, there are discernible differences at times.  Both start with small patches of hair loss but Alopecia Areata usually appears more symmetric and round.  Most forms of Scarring Alopecia have ‘ragged’ edges and there will probably be some indication of inflammation, lesions, puss and/or skin discoloration that would not be present with Alopecia Areata.  Also, Scarring Alopecia may be accompanied by itching, pain and/or a burning sensation.  At some point Scarring Alopecias burn themselves out and the bald spots will stop growing.  At this point the physical discomfort usually subsides.  Unfortunately, even when a definitive diagnosis of Scarring Alopecia can be made through a visual examination, treatments will most assuredly vary depending on what type it is.

Various Types of Scarring Alopecias

First of all, it is important to realize that most types of Scarring Alopecia are extremely rare.  Probably less than 3% of all  hair loss cases can be attributed to all of the Scarring Alopecia diagnoses combined.  There are so many classifications that it would be difficult to name them all and even more difficult to pronounce them!  To cite just a few of them, examples would include follicular degeneration syndrome, eosinophilic pustular folliculitis, lichen planopilaris, folliculitis decalvans  and dissecting cellulitis.  And that is just a few of many!  Each is treated uniquely once a diagnosis has been confirmed.

Scarring Alopecia Treatments

Treatments will vary significantly depending on the type of Scarring Alopecia, but the one factor that is common throughout is that because it can result in much damage to the scalp, all treatments should be extremely aggressive.  This is because hair loss will be permanent and it is imperative to try to halt the progression of the bald spot.  Treatments will include anything from topical or subcutaneous (under the skin) injections of corticosteroids to antibiotics and isotretinoin.  Isotretinoin is interesting in that it is often used to treat severe acne however it was developed to treat certain forms of cancer and is still in use today as an effective form of chemotherapy.  Having said that, don’t be frightened if your doctor prescribes that for your hair loss.  It doesn’t mean you have cancer!  It works by destroying cells that divide rapidly.  That is a characteristic of cancer, in fact that’s what cancer is, but it is also a characteristic of some forms of Scarring Alopecia, albeit benign.

Closing Thoughts: Scarring Alopecia is Rare

The problem with talking about Scarring Alopecia is that many people become frightened when they notice a small bald spot beginning on their scalp.  Chances of it being Alopecia Areata are much greater than of it being one of the forms of Scarring Alopecia.  Alopecia Areata is reversible and does not usually result in permanent hair loss while Scarring Alopecia results in a permanent bald spot that will need to be surgically corrected through some type of transplant, grafting and/or surgical manipulation.  Remember, less than 3% of all cases of hair loss can be attributed to one of the many forms of Scarring Alopecia.  As is the case whenever you notice you are losing hair, a definitive diagnosis is necessary prior to any treatments whatsoever.  Only a trained medical professional has the ability to accurately diagnose what is going on and whether or not there are any known effective treatments available.  It is never in your best interest to self-diagnose, however, once a diagnosis is established you are free to choose your treatment or not as the case may be.  Some forms of Alopecia are treatable with natural or homeopathic remedies while others are not.  But, treatment always begins with a diagnosis.

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