Cicatricial Alopecia [Scarring Hair Loss]

Scarring alopecia (scarring hair loss) is a type of hair loss characterized by permanent destruction of hair follicles and the formation of scar tissue in their place. This situation leads to irreversible loss of hair follicles and typically arises as a result of an underlying skin disease or trauma. Scarring alopecia can occur in both men and women and may lead to permanent bald patches if left untreated. This form of hair loss may be more than a cosmetic issue, as it can be a sign of a serious underlying condition.

Causes of Scarring Alopecia

Scarring alopecia can arise from various causes, including inflammatory skin diseases, infections, physical or chemical trauma, and rare genetic disorders. Conditions that cause scarring alopecia damage hair follicles and trigger the formation of scar tissue.

Inflammatory Skin Diseases

• Lichen Planopilaris: A form of lichen planus affecting the scalp. It causes inflammation of hair follicles and subsequent scarring.
• Discoid Lupus Erythematosus: A chronic autoimmune disease that produces red, scaly lesions on the scalp and leads to scarring hair loss.
• Folliculitis Decalvans: A condition resulting from chronic inflammation of hair follicles, leading to scarring hair loss.

Infections

• Fungal Infections: Severe fungal infections of the scalp, particularly those known as kerion, can cause scarring hair loss.
• Bacterial Infections: Bacterial infections such as folliculitis and carbuncles can damage hair follicles.

Trauma

• Physical Trauma: Burns, radiation therapy, or surgical procedures can cause permanent destruction of hair follicles.
• Chemical Trauma: Chemical agents applied to the scalp or aggressive hair treatments can lead to scarring hair loss.

Genetic Disorders

• Follicular Mucinosis: A rare genetic disorder characterized by abnormal accumulation of mucin in hair follicles, resulting in scarring hair loss.

Clinical Features of Scarring Alopecia

Scarring alopecia is characterized by areas of baldness on the scalp that may have regular or irregular shapes. In these areas, hair follicles are completely destroyed, and scar tissue is visible on the skin. Associated symptoms may include itching, burning, pain, and redness of the skin. In some cases, scaling or crusting of the scalp may also be observed.

Diagnosis of Scarring Alopecia

The diagnosis of scarring alopecia is made through clinical examination and, when necessary, biopsy. Dermatologists can make a diagnosis based on the appearance of bald patches and associated symptoms. A biopsy is performed to determine whether hair follicles have been destroyed and whether scar tissue is present. Additional laboratory tests and imaging methods may also be used to investigate underlying causes.

Treatment of Scarring Alopecia

The treatment of scarring alopecia is planned according to the underlying cause and the severity of the disease. The primary goals of treatment are to control inflammation, halt disease progression, and improve cosmetic appearance. However, since scarring hair loss is irreversible, regrowth of lost hair is not possible.

Medical Treatment

• Topical and Systemic Corticosteroids: Used to reduce inflammation. Topical corticosteroids are preferred for mild cases, while systemic corticosteroids are used for severe cases.
• Antibiotics and Antifungal Agents: Used in cases of scarring alopecia caused by infection.
• Immunosuppressive Drugs: Used in autoimmune-related scarring alopecia, such as discoid lupus erythematosus.

Surgical Treatment

• Hair Transplantation: Hair transplantation may be an option to improve cosmetic appearance in scarred areas. However, this procedure is only performed when the disease is no longer active.
• Surgical Removal of Scars: Small scar areas can be surgically excised, followed by hair transplantation in those regions.

Supportive Therapies

• Psychological Support: Scarring alopecia can cause psychological distress, particularly due to its impact on appearance. Therefore, providing psychological support to patients is essential.
• Wigs: For patients with permanent hair loss, wigs can serve as a cosmetic solution.

Prevention of Scarring Alopecia

Prevention of scarring alopecia is possible through early diagnosis and treatment of underlying causes. In particular, early treatment of inflammatory skin diseases can prevent damage to hair follicles. It is also important to avoid chemical agents applied to the scalp and aggressive hair treatments.