Scarring Alopecia

Scarring alopecia is a rare form of hair loss in which the hair follicles are destroyed and replaced with scarring fibrous tissue. The first symptoms usually occur as small patches of hair loss that may expand with time. For some, the hair loss occurs gradually and isn’t noticed. For others, hair loss may be very sudden and may be accompanied by pain, irritation and inflammation of the scalp. Primary causes of scarring alopecia include folliculitis decalvans, folliculitis kelodalis, lichen planopilaris and discoid lupus erythematosus. Bacterial or fungal infections can also cause damage and destroy hair follicles, causing scarring alopecia. Common secondary causes of scarring alopecia include cellulitis infection of the scalp, as well as Tinea capitis, a common fungal infection of the scalp usually seen in children.

Common symptoms of scarring alopecia include:

  • Sudden thinning and loss of hair
  • Scar tissue that forms over the scalp with loss of hair follicles
  • A tingling or stinging sensation in areas of hair loss
  • Inflammation of the hair follicles

The primary causes of scarring alopecia include:

Folliculitis Decalvans: This condition refers to hair loss due to recurring patchy and painful follliculitis. The loss of hair is thought to be a result of the constant presence of crusting pustules which leave an area devoid of hair. Tufting of hair is also frequently seen in this condition.

Folliculitis Kelodalis: Also known as acne keloidalis nuchae or AKN, this condition refers to chronic pustular or popular eruption that is specific to the scalp or the neck area resulting in keloid scars. This condition is most common in men of a darker skin color, but some cases involve women and caucasians. Early lesions are often found on the lower scalp, and cause reddening of the skin. Close shaving, constant rubbing, and otherwise picking the skin, is thought to aggravate the skin and cause AKN, so should be avoided.

Lichen Planopilaris:This condition, also known as acuminatus, is a symptom of lichen planus which causes hair loss. Lesions become red around the hair follicles, and eventually scar, later becoming devoid of hair as it progresses. If inflammation is controlled during the early stages, the follicles can be left intact, and hair may later grow.

Lupus Erythematosus: Both systemic and discoid lupus can involve the scalp, and is a form of primary scarring alopecia. Lesions start as red and scaly plateau like bumps, and may later evolve into scars without hai.

Use gentle shampoos and conditioners to cleanse the hair. After washing your hair, let it naturally air dry. Hot air dryers can often damage hair and cause it to break. Activities such as over-brushing or over-styling the hair can often lead to more hair loss. Use a large toothed comb to minimize the risk of breaking or pulling out hair. Avoid hairstyles that pull on the hair such as ponytails. Cut back on hair styling products that contain alcohol, which may irritate the scalp.

The best strategy is to consult a dermatologist when you first notice any signs of excessive shedding to make certain that an underlying medical condition is not the actual cause. Only a qualified physician can dispense proper advice and medical treatments to minimize or reverse hair loss.

  • Do not rupture whiteheads, blackheads or pimples
  • Avoid astringents (containing alcohol) that may dry out and irritate the skin
  • Let scabs run their course – do not pick or remove them
  • Use a non-greasy sunscreen when outdoors for extended periods of time

Prescription
Treatment of scarring alopecia depends largely on the cause. For scarring alopecia caused by folliculitis decalvans, topical treatments such as fusidic acid and the long-term use of oral antibiotics are often used to reduce inflammation. For cases caused by folliculitis kelodalis, optimal treatment depends on the severity of the condition and can vary from the use of topical antiseptics, antibiotics and corticosteroids. For cases caused by lichen planopilaris, treatment involves topical, intralesional, and oral corticosteroids, anti-malarials (for their anti-inflammatory effect), and antibiotics. For cases caused by lupus erythematosus, active lesions are typically treated with topical and intralesional corticosteroids.

Procedures
In cases involving folliculitis kelodalis, surgical excision may be required to remove affected parts of the skin.