Overview

Cicatricial alopecias are a group of rare hair loss disorders where hair follicles are destroyed and replaced by scar tissue. This destruction means the hair loss is, unfortunately, permanent in the affected areas. The exact cause often involves inflammation directed at the hair follicles, though what triggers this inflammation can vary or sometimes be unknown.

These conditions can affect anyone, regardless of age or gender, though some types are more common in certain groups. Importantly, cicatricial alopecias are not contagious, so you don't have to worry about spreading them to others. Living with any form of hair loss can be challenging, and the permanent nature of cicatricial alopecia can significantly impact self-esteem and emotional well-being. Please know that you're not alone in this.

Symptoms

Symptoms can vary depending on the specific type of cicatricial alopecia, but here are some common signs you might notice:

• Patches of hair loss that may slowly get bigger over time.
• Itching, burning, pain, or tenderness on the scalp, especially in the areas of hair loss.
• Redness, scaling, or flaking on the scalp.
• Small bumps, pimples, or pustules around hair follicles in the affected areas.
• In some cases, the scalp skin in the affected areas might look smooth, shiny, and devoid of hair follicle openings.
• Symptoms can range from mild and barely noticeable to quite severe and uncomfortable.
• Sometimes, there are no noticeable symptoms other than the hair loss itself.

Diagnosis

Diagnosing cicatricial alopecia usually involves a careful examination of your scalp by a dermatologist. Because these conditions can look like other types of hair loss, a scalp biopsy is almost always needed. This is a simple procedure where a very small piece of scalp skin (about 4mm) is taken, usually after numbing the area, and examined under a microscope. This helps to confirm the diagnosis, identify the specific type of cicatricial alopecia, and see how active the inflammation is. Your doctor will also ask about your medical history and any symptoms you're experiencing.

Management & Treatment

Receiving a diagnosis of cicatricial alopecia can feel unsettling, and we want you to know that support and treatment options are available. The primary goal of treatment is to slow or stop the inflammation that is damaging the hair follicles, which can help prevent further hair loss. Since this condition involves scarring, starting treatment as early as possible is crucial for the best outcome.

Cicatricial alopecia does not resolve on its own. The inflammation, if left untreated, will continue to cause permanent hair loss. This is why seeking care from a dermatologist is so important.

Treatment Approaches

Because the main issue is inflammation, treatments are focused on calming the body's immune response in the scalp. There isn't a one-size-fits-all solution, and your dermatologist will create a plan tailored to your specific needs.

• Corticosteroids: These are powerful anti-inflammatory medications. They can be applied directly to the scalp as a cream, foam, or lotion (topical) or given as small injections into the affected areas (intralesional). These are often the first line of treatment.
• Oral Medications: If the hair loss is progressing quickly or not responding to other treatments, your doctor may prescribe pills. These can include antibiotics like doxycycline or tetracycline (used for their anti-inflammatory effects, not to treat an infection), or other medications that help regulate the immune system, such as hydroxychloroquine.

Home Care and Lifestyle

While medical treatment is necessary, how you care for your hair and scalp at home can make a real difference.

• Be Gentle: Avoid hairstyles that pull on the scalp, such as tight braids or ponytails.
• Avoid Harsh Chemicals: Try to limit the use of hair dyes, chemical relaxers, or harsh styling products that could irritate the scalp.
• Reduce Heat: Limit your use of blow dryers, flat irons, and curling irons, which can cause more stress to the hair and scalp.

Treating cicatricial alopecia is often a long-term process. It can take several months to see if a treatment is successfully stopping the inflammation. The first sign of improvement is usually a decrease in symptoms like itching, burning, and redness.

It is important to understand that treatment is meant to prevent future hair loss. Unfortunately, hair is unlikely to regrow in areas where scarring has already occurred.

When Treatments Aren't Working

Living with this condition can be frustrating, especially if your first treatment plan isn't as effective as you hoped. It's very important to keep your follow-up appointments with your dermatologist. They can assess your progress and adjust your treatment plan. Sometimes, a combination of therapies is needed to get the inflammation under control.

Once the condition has been inactive for a year or two, some people may be candidates for surgical options like hair transplantation to cover scarred areas. However, this is only considered when the inflammation is completely gone.

Duration & Outlook

Cicatricial alopecias are typically chronic conditions, meaning they can last for a long time, sometimes progressing slowly over years. Unfortunately, because the hair follicle is destroyed and replaced by scar tissue, the hair loss in the affected areas is permanent – the hair will not regrow in those scarred spots. The main goal of any intervention is to try and stop or slow down further inflammation and prevent more hair loss.

Warning signs for complications or worsening of the condition include rapidly expanding areas of hair loss, or a significant increase in scalp symptoms like pain, intense itching, or discharge. If you notice these, it's important to see your doctor.

Prevention

For many types of primary cicatricial alopecias (where the hair follicle itself is the target of inflammation), the exact cause is unknown, making them difficult to prevent. However, for secondary cicatricial alopecias, which occur after an injury, severe infection, burn, or radiation, preventing the initial damage can prevent this type of scarring hair loss.

While not a direct prevention for primary types, avoiding harsh chemical treatments, tight hairstyles that pull on the scalp excessively, and promptly treating scalp infections might help maintain overall scalp health, though this isn't a guaranteed way to prevent cicatricial alopecia.

Causes & Triggers

The exact cause of most primary cicatricial alopecias isn't fully understood, but it involves inflammation that targets and destroys the hair follicles, leading to scarring. It's thought that the body's immune system may mistakenly attack the hair follicles. Genetics might play a role for some individuals, making them more susceptible.

Secondary cicatricial alopecias are caused by an external injury or process that destroys the hair follicles, such as:

• Severe burns (thermal or chemical)
• Deep bacterial or fungal infections of the scalp
• Physical trauma to the scalp
• Radiation therapy to the head
• Certain inflammatory skin conditions that can lead to scarring, like severe forms of lupus affecting the skin.

It's often difficult to pinpoint specific triggers for primary cicatricial alopecias. For secondary types, the trigger is the initial injury or infection.

Anyone can develop cicatricial alopecia, but some specific types are more common in certain demographic groups (e.g., Lichen Planopilaris is more common in middle-aged women, and Central Centrifugal Cicatricial Alopecia is most common in women of African descent). Having an autoimmune condition might be a risk factor for some types.

When to see a doctor

It's so important to see a doctor, preferably a dermatologist, if you notice:

• Any new patches of hair loss, especially if they seem to be slowly getting larger.
• Persistent itching, burning, pain, or tenderness on your scalp.
• Redness, scaling, pustules, or sores on your scalp, particularly in areas where hair is thinning.
• If your scalp in the area of hair loss looks very smooth, shiny, or scarred.

Early diagnosis is really key. While we can't reverse the scarring that has already occurred, getting an accurate diagnosis as soon as possible can help explore options to try and control the inflammation and potentially slow down or stop the progression of further hair loss. Don't hesitate to reach out for help; your well-being is important.

Frequently Asked Questions (FAQs):

• Will my hair grow back if I have cicatricial alopecia?
  Unfortunately, in areas where scarring has already occurred and destroyed the hair follicle, the hair loss is permanent, and the hair will not regrow in those specific spots. The goal is to prevent further scarring and hair loss.
• Is cicatricial alopecia painful?
  It can be. Some people experience pain, itching, burning, or tenderness on their scalp, especially in the active areas of inflammation. Others may have no discomfort at all, only noticing the hair loss.
• Can stress cause cicatricial alopecia?
  While stress can sometimes trigger or worsen other types of hair loss (like telogen effluvium), there's no direct evidence that stress causes primary cicatricial alopecias. However, living with a chronic condition like this can certainly be stressful.
• Is there a cure for cicatricial alopecia?
  Currently, there is no cure that can reverse the scarring and make hair regrow in the scarred areas. The focus is on managing the condition to stop or slow its progression.
• How is cicatricial alopecia different from male/female pattern baldness?
  Male and female pattern baldness (androgenetic alopecia) involves the gradual shrinking of hair follicles but doesn't typically cause the inflammation and permanent scarring that destroys follicles seen in cicatricial alopecias. Also, the pattern of loss and scalp symptoms (like itching or pain) are often different. A scalp biopsy can clearly distinguish between them.