Hair Loss From Cicatricial Alopecia
What is Cicatricial Alopecia?
Cicatricial Alopecia, or Scarring alopecia, is the name given to hair loss from a group of conditions brought on by an inflammation of the scalp. They destroy the hair follicles and replace them with scar tissue, meaning hair can no longer grow.
Although the conditions are also known as forms of ‘scarring alopecia’, the scar tends to be below the surface of the skin, meaning it is not visible. However, this is not the case where the condition occurs as a result of severe burns to the scalp.
These conditions are fairly rare but can affect both men and women, although children may also be affected, and can cause permanent hair loss.
They are not contagious and tend to affect individuals rather than running in families, so cicatricial alopecia is unlikely to be inherited.
Types of cicatricial alopecia
There are two categories of cicatricial alopecia – primary and secondary.
Primary cicatricial alopecia conditions target the hair follicles directly, whereas in cases of secondary cicatricial alopecias the hair follicle is collateral damage following another health condition or an injury, such as burns, radiation or traction. This is why secondary cicatricial alopecia is often found in cases of advanced traction alopecia.
Primary cicatricial alopecias such as lichen planopilaris, frontal fibrosing alopecia and pseudopelade can come on gradually with no symptoms, meaning the condition often goes unnoticed until excessive shedding become obvious. However, they can also progress rapidly and show signs of redness, a scaliness of the scalp, pustules or increased/decreased pigmentation. These can cause itching, burning and scalp pain.
What are the causes?
Cicatricial alopecia can have a number of causes, although this is an area in which more research is still needed to establish a definitive criteria.
What is known is that all cicatricial alopecias involve inflammation which directly targets the stem cells and sebaceous gland in the upper part of the hair follicle. Once these are destroyed, the hair follicle dies, resulting in permanent hair loss.
Cicatricial alopecias do not tend to be hereditary, although central centrifugal cicatricial alopecia – often referred to as Follicular Degeneration Syndrome as the conditions are believed to be closely linked or synonymous – which is most commonly found in women of African ancestry, does sometimes present in women from the same family.
What is the best treatment for cicatricial alopecia?
Although there are trials going on which hope to develop treatments for cicatricial alopecia, at present there is no effective treatment for most instances of these conditions. The one exception being treatment for central centrifugal cicatricial alopecia, which has been seen to respond positively to minoxidil, producing promising results in the mild-to-moderate stages of this condition.
Steroids, anti-inflammatories and tetracycline are sometimes used to treat scarring alopecia but they are not thought to be particularly successful. Also, once the hair follicles have been destroyed and scarred over, hair can no longer regrow naturally in these locations. Hair loss treatments promote regrowth by stimulating the hair follicle, however, as in cases of cicatricial alopecia the hair follicles are dead, there is nothing to stimulate so these cannot work here.
It is possible for some hair transplant operations to be performed on a scarred scalp, but a highly skilled and reputable surgeon would need to assess suitability first on an individual basis.
As a non-surgical option, hair replacement solutions such as lace-front wigs can provide natural looking, confidence-boosting coverage for those who want to maintain the appearance of having hair.