Ultrasound Techniques Used to Assess Cicatricial Alopecia

Cicatricial Alopecia refers to a group of conditions which all the hair follicles are permanently destroyed, leading to scarring hair loss which is often permanent.

It is generally diagnosed via a scalp biopsy, though some forms of cicatricial alopecia, such as Frontal Fibrosing Alopecia, present in established patterns and so may be spotted by a hair loss specialist via a simple visual assessment.

A report published in the Skin Research & Technology journal on 29th May 2019 by members of the dermatology and radiology departments from the Faculty of Medicine at Selcuk University, Selçuklu, Turkey, explains their use of ultrasound techniques as a novel approach to exploring Cicatricial Alopecia.

Examining tissues using ultrasound

The reason scalp biopsies tend to be used in diagnosing Cicatricial Alopecias is that it is an effective method of showing the level of inflammation present.

As such, for conditions where there are few outward signs other than this inflammation, the biopsy method is currently extremely useful.

This Turkish study employed a combination of shear wave elastography (SWE) and superb microvascular imaging (SMI) to explore the differences between areas of cicatricial alopecia and unaffected 'normal' scalp areas. Researchers aimed to establish how feasible it would be to use these technologies for such assessments.

Using an Aplio 500 system for the trials, these "noninvasive ultrasonic techniques" evaluated thickness, stiffness, and the vascular index of skin tissues in 17 patients with Cicatricial Alopecia as well as 20 healthy control participants without hair loss.

The mean age of patients in the Cicatricial Alopecia group was 37 years old (± 13.16), whilst for the healthy controls it was 36 years of age (± 11.79).

SWE results in cicatricial plaques were found to be higher than healthy, unaffected scalp areas in patient group; SMI values for the Cicatricial Alopecia patient group were noted as being "significantly higher" than those recorded for the control group.

The full results can be found in the report abstract.

Study conclusions

In conclusion, the study authors state, "To the best of our knowledge, this is the first study to evaluate SWE and SMI scores in cicatricial alopecia. We found higher stiffness and vascularity in patient group. We conclude that SWE and SMI can show fibrosis and inflammation like previous studies. Especially, SWE as m/s is more sensitive than as kPa for cicatricial alopecia".

Therefore it seems these ultrasound techniques may be beneficial in helping to determine factors associated with Cicatricial Alopecia.

Whether or not they could potentially replace the need for diagnosis using a scalp biopsy where scarring hair loss is suspected, remains to be seen, though.

Presently there are a limited number of scarring hairloss conditions which can be treated, such as Follicular Degeneration Sydrome. It is often the case that treatment revolves around the patient's doctor or dermatologist prescribing them medication to help manage the associated inflammation, rather than using anything for hair regrowth.

Sometimes hair restoration surgery may be a viable option but, as there are many factors involved in determining whether a patient is suitable for a hair transplant - including scalp health, blood supply to scarred areas and the availability of enough good quality donor hair - this is decided on a case-by-case basis by highly-specialist surgeons.