Scarring alopecia, also known as cicatricial alopecia, is a hair loss condition caused by the destruction of hair follicles — the structures on the surface of the skin that grow hair. It can result from chemicals, infections, burns, or autoimmune disorders.
The condition usually starts as a bald patch on the scalp. Over time the number of patches increases, and the skin where hair is lost begins to look smooth and shiny. The appearance varies from person to person, and some people also experience flaky skin, blisters, and redness. There are two types.
- Primary scarring alopecia: caused by an inflammatory or autoimmune disorder that directly targets and destroys hair follicles.
- Secondary scarring alopecia: a result of injury or damage to the skin, with hair loss caused by burns, infections, radiation, or a tumour.
What are the causes of scarring alopecia?
The primary cause is inflammation around the bulge of the follicle, the part that contains the stem cells and oil glands needed for new hair growth. Increasing inflammation destroys this area, causing scar tissue to form and preventing hair from regenerating. Scarring alopecia requires prompt medical attention and treatment.
What are the treatment options for scarring alopecia?
Topical treatments
Topical treatments are the first line of treatment. The dermatologist may recommend topical or injectable steroids. For larger areas, clobetasol works well; for smaller areas, the dermatologist may use Kenalog injections.
Prescription medicines
Depending on how quickly you are losing hair, the dermatologist may combine topical treatment with prescription medicine. Two of the most commonly used drugs are hydroxychloroquine and doxycycline, valued for their anti-inflammatory effect and suitable for many patients. If these cause side effects, the dermatologist may recommend low-dose naltrexone (LDN) as an alternative — a well-tolerated medicine with promising results for scarring alopecia.
Low-level laser therapy
Low-level laser therapy (LLLT) offers notable benefits for people with scarring alopecia. Studies suggest it decreases inflammation and helps restore hair once the inflammation is controlled, allowing the healing process to begin.
Platelet-rich plasma therapy
Platelet-rich plasma (PRP) therapy is another option. This in-office treatment involves injecting the patient's own platelets across the bald spots to encourage hair growth, and may help repair and rejuvenate hair follicles. Although not the first line of defence, PRP therapy can be combined with medication and other treatments, and you may require multiple sittings depending on how your body responds.
Hair transplants
Hair transplants are the last line of treatment and are used in cases of significant hair loss. While the procedure can restore hair, it is not possible to transplant into an actively inflamed area, so the dermatologist may not recommend it until the area has been inactive for at least one to two years.
Early diagnosis matters
Acting early gives the best chance of halting progression and protecting the hair you still have. At Derma Essence, treatment is led by Dr. Reena Sharma (MD Dermatology). For related concerns, see alopecia areata or hair fall in men.
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