Scarring Alopecia

As a whole, alopecia can be emotionally scarring, causing stress and self-consciousness that can ruin a person’s social life. Unfortunately, there’s another type of scarring alopecia and that’s the type that leaves physical—potentially permanent—scars across the scalp and possibly other body parts with hair.

What is Scarring Alopecia?

Scarring alopecia is marked by the destruction of hair follicles which is irreversible. After the hair follicles are destroyed, they are replaced with scar tissue, leaving permanent, visible scars across the scalp. In most cases, the scarring won’t occur until later on, after small patches of hair loss have begun to form. Gradually, these patches expand, making it very difficult to foretell the onset of scarring alopecia.

In some cases, scarring alopecia will be accompanied by severe itching, pain and burning sensations as the hair loss progresses rapidly. As the follicles of hair die, scar tissue is formed, leaving disfiguring scars which can be psychologically worse than the physical pain.

What Does Scarring Alopecia Look Like?

As opposed to other forms of alopecia like alopecia areata, scarring alopecia typically doesn’t have defined edges to the bald spots, but rather a jagged, tattered edge. Since the hair follicles are being destroyed from within the skin, other than the edges of the hairline around the bald patches, the skin’s surface will look rather normal for alopecia. In most cases the skin will be smooth, but in some instances, there might be scaling, redness and change in skin pigment (either darker or lighter). In severe cases, blisters and pus-filled sores will arise, seeping fluids out of the scalp.

During the onset of scarring alopecia, the cells around the hair follicles will often become inflamed as they are being destroyed, leading to the creation of scar tissue. The good news is that over time, the bald patch will stop expanding on its own and any burning, pain or itching subsides with time. The down side to this is that long or deep scars are left in the follicles place, though on occasion some hair follicles which aren’t completely decimated can grow back.

What Causes Scarring Alopecia?

Scarring alopecia can be developed either naturally or by outside influence. In the later scenario, a burn, surgery, infection, tumor or radiation can cause the destruction of the hair follicle, resulting in the scars. In the former scenario, immune cells in the body called lymphocytes or neutrophils attack the hair follicles, first inflaming it and then destroying it. The stem cells and oil glands at the base of the hair follicle are damaged permanently, leading to permanent hair loss without the ability to regrow hair.

How Can I Tell if I Have Scarring Alopecia?

If you suspect you have scarring alopecia, your doctor will likely take a scalp biopsy to confirm or refute your suspicions. In some cases of any alopecia, the doctor will perform this without your prompts. The biopsy will give extra information about the types of cells that are at work with your alopecia as well as the level of inflammation and condition of the oil glands. Comparing your scalp to previous visits, your doctor will also monitor the progress of your alopecia. If the doctor diagnoses you with scarring alopecia, he or she will then prescribe a treatment plan for moving forward.

How Do You Treat Scarring Alopecia?

The earlier that you catch scarring alopecia, the better chance you have at curbing the potential scarring that will occur. The best scenario is catching it early and then beginning aggressive treatment before a vast amount of hair loss occurs. Depending on the extent of your hair loss as well as how progressed your scarring alopecia is (as well as whether neutrophils, lymphocytes or both are causing the hair follicle destruction), your doctor has a few courses of action to recommend:

For scarring alopecia caused by lymphocytes, oral antibiotics, immunosuppressive drugs, antimalarials and thiazolidinediones can be used. For topical treatment, a variety of tacrolimus or corticosteroids can be used to suppress the immune system. Corticosteroids may also be injected directly into the scalp at the affected areas.
For scarring alopecia caused by neutrophils, antibiotics and anti-inflammatory medications are administered both orally and topically.
For scarring alopecia caused by both lymphocytes and neutrophils, antimicrobials, anti-inflammatory medications and retinoids are used.

The purposes of all these treatments isn’t to restore the hair follicle after it’s been destroyed (because that’s impossible with modern technology, but maybe in the future), but rather to stimulate other hair follicles around the area to ward off spreading the permanent damage. Doctors can also prescribe antihypertensives to stimulate hair growth in any healthy hair follicles.

Expect treatments to be long and intensive, doing all they can to ward off scarring alopecia from becoming disfiguring. To find out more about advanced treatment methods of alopecia, contact us right now.