Scarring alopecia: Description, Causes and Risk Factors:Alternative Name: Scarring alopecia, cicatricial alopecia.Scarring alopecia refers to a diverse group of rare disorders that destroy the hair follicle, replace it with scar tissue, and cause permanent hair loss. During the active, evolving stage of hair loss, patches of scarring alopecia commonly appear red and inflamed at the base of the hair shaft. Sometimes crops of pustules are noted. Some types of scarring alopecia destroy the hairs deep within the scalp, without inflammation visible on the skin surface. While some types of scarring alopecia result in rapid hair loss, slow progression of hair loss is more common.This disease affect both men and women, most commonly young adults although all ages may be affected. There have been a few reports of cicatricial alopecia occurring in a family.In general scarring alopecia is the result of destruction of the hair follicle causing it to be replaced by scar tissue. Diseases that cause cicatricial alopecia include systemic lupus erythematosus, lichen planus, persistent bacterial or fungal infections, and skin cancer. The skin may also be damaged from burns, other physical injuries, and radiation therapy.Types may include:Primary cicatricial alopecia.
Secondary scarring alopecia.
In primary scarring alopecia, the hair follicles are destroyed by an inflammatory process, which usually involves lymphocytes, neutrophils or other inflammatory cells. Such a condition can be caused by autoimmune disorders. Depending on the type of inflammatory cells involved, primary cicatricial alopecia is further classified into three main types, which are known as lymphocytic, neutrophilic and mixed alopecias.On the other hand, secondary scarring alopecia results from factors like burn, injury or severe infections that leave scars on the scalp and cause hair loss on the affected areas.It is easy to identify a case of severe cicatricial alopecia because there will be rough patches on the surface of the scalp made up of small blood vessels and connective tissue.Symptoms:Clinical signs may include:Obvious areas of baldness.
Lack of follicular ostia.
Involved hairs oftenprotrude from the scalp atan odd oblique angle or inabnormal groups of hair.
Itching and a burning sensation present.
Redness, fluid filled blisters or pustules and scarring may occur in the affected area.
Diagnosis:A careful physical examination, scalp biopsies and blood tests can be helpful in order to establish the correct diagnosis and to suggest the most appropriate treatment for scarring alopecia.Biopsies are best done of active, inflamed sites on the scalp which still have remaining hair. A biopsy of an older scarred area may be helpful to predict the likelihood of re-growth of hair, and to help establish the diagnosis by evaluating the pattern of scar formation. If certain types of the disease are suspected, your doctor may send a biopsy specimen for additional special tests including direct immunofluorescence, and special stains for bacteria, fungi and elastic tissue. In some infectious disorders that can cause scarring alopecia, a biopsy must be sent for tissue culture.Treatment:Treatment for the disease remains poor. The main goals of treatment for cicatricial alopecia are to prevent further hair loss and to eradicate or at least lessen the redness, scale and itching associated with the process. There are no current FDA approved treatments for scarring alopecia although the NAHRS (North American Hair Research Society) has been working to initiate interest in this area among industry sponsors. All treatment now for scarring alopecia is strictly based on the experience of the prescribing physician or anecdotal reports as there has never been any multicenter clinical trial in this area.Treatment of the lymphocytic group of the disease involves use of antiinflammatory medications. The goal of treatment is to decrease or eliminate the lymphocytic inflammatory cells that are attacking and destroying the hair follicle. Oral medications may include hydroxychloroquine, doxycycline, mycophenolate mofetil, cyclosporine, or corticosteroids. Topical medications may include corticosteroids, topical tacrolimus, topical pimecrolimus, Derma-Smoothe/FS scalp oil, triamcinolone acetonide (a corticosteroid) may be injected into inflamed, symptomatic areas of the scalp.Treatment of the neutrophilic group of scarring alopecias is directed at eliminating the predominant microbes that are invariably involved in the inflammatory process. Oral antibiotics are the mainstay of therapy, and topical antibiotics may be used to supplement the oral antibiotics. Isotretinoin is sometimes helpful in controlling the neutrophilic group, especially dissecting cellulitis.Treatment of the mixed group of cicatricial alopecia may include antimicrobials, isotretinoin (especially for folliculitis keloidalis), and anti-inflammatory medications.You should discuss any treatment with your dermatologist who will also explain potential side effects of the treatment.Surgical treatment is not an option in most cases except under certain conditions if the disease has been inactive for many years and the area of hair loss is small, then surgical removal of the scarred scalp and/or hair transplants may be considered for cosmetic benefit.Disclaimer: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.
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