Medically reviewed by Kristin Hall, FNP
Written by Our Editorial Team
Last updated 4/23/2021
Hair loss is, for most people, bad news. Aside from those of us lucky enough to look good bald (and perhaps including them) most people don’t choose to be hairless.
As a result, most people might correctly believe that, to a certain extent, all hair loss is bad hair loss. But the reality is that, while all hair loss results in lost hair, some types of hair loss result in more permanent damage, and even scar tissue.
If you’re worried about the early signs of cicatricial alopecia, commonly known as “scarring” alopecia, there may not be a lot of good news to share, but first let’s examine this rare type of hair loss.
According to the Canadian Medical Association Journal, cicatricial alopecia, or scarring alopecia, is actually not just one disorder, but rather a group of hair loss types involving permanent damage and development of scar tissue for hair follicles.
There are two classifications of cicatricial alopecia: primary and secondary.
Primary cicatricial alopecia is defined by hair follicles being damaged by inflammation beneath the skin’s surface, which leads to that tissue being replaced with scar tissue and hair loss being permanent.
Secondary cicatricial alopecia, in contrast, is actually a symptom or side effect of something else. That could include a burn, infection, or a tumor. In this case the damage to the follicle, while externally caused, is still permanent.
Scarring alopecia symptoms include pigment changes for the skin, as well as scaling, redness, and the development of pustules.
Cicatricial alopecia is rare compared to other forms, and as such it’s important to denote some other forms of hair loss that may initially resemble scarring alopecia, but in fact have different causes. The two that might easily be misdiagnosed also can cause sudden, irritated patches of baldness: traction alopecia and alopecia areata.
Like secondary scarring alopecia, traction alopecia is often the result of an injury to the scalp or hair follicle, but in this case it is often caused by hair styles. Tight ponytails or manbuns, or anything that pulls at or strains the hair follicle may cause this damage (which is why it’s sometimes called traumatic alopecia). You can also cause traction alopecia by literally pulling out your own hair—a psychological condition referred to as trichotillomania.
The key difference is that traction alopecia doesn’t often result in scarring, and can sometimes be reversed.
Like scarring alopecia, alopecia areata is somewhat miscategorized because, unlike traditional baldness as we know it, it is actually an autoimmune disease symptom. Essentially, the immune system attacks the follicles, eventually causing them to stop growing. Some scarring alopecia can be caused by autoimmune diseases.
Autoimmune hair loss is difficult to reverse and is best treated by treating the underlying disease causing the problem. And again, it doesn’t tend to cause scarring.
Treating primary scarring alopecia requires treating the inflammation causing the condition, which might involve the use of anti-inflammatory medications, antibiotics and corticosteroids. Unfortunately the damage is not reversible by current medical standards, so the best “treatment” is early detection and minimization of the damage.
Treatments aren’t simple though, because of the variety of underlying causes that can create inflammation and damage. Instead, expect a healthcare professional to prescribe one or several treatments to halt the progress of the disease. Common treatments include:
Anti-inflammatory medications (to stop the inflammation and mitigate the damage).
Corticosteroids (to treat certain underlying conditions that may cause the disease).
Immunosuppressants (to mitigate the damage in the case of an autoimmune cause).
As you might be able to tell, this is a problem best addressed with a healthcare provider, and as quickly as you think you see signs of scarring alopecia, you should reach out for help.
The clock is unfortunately against you if you have this condition—and as much as we’d love to tell you topical or oral medications might help, the best longshot options for solving the problem involve removing the damaged tissue and doing a hair transplant after the inflammation has been stopped for some time.
If you think you might have cicatricial or scarring alopecia, consult a healthcare professional immediately.