Scarring Alopecia
The Truth About Scarring Alopecia
Scarring alopecia is sometimes called cicatricial alopecia, and is a group of disorders dealing with hair loss. These may be the cause of baldness in about three percent of patients experiencing hair loss. It is found throughout the world, and occurs in men – and women – who are otherwise healthy.
Each individual diagnosis within the group is rather rare, but some examples of the disorder include pseudopelade of Brocq, lichen planopilaris, folliculitis decalvans, follicular degeneration syndrome, eosinophilic pustular folliculitis and dissecting cellulitis. Scarring alopecia can also be a significant part of a larger medical condition like chronic lupus, where more organs than the hair can be affected.
There are many different forms of this disorder, but the most common way it presents is as a possibly permanent and irreversible destruction of follicles of hair, which are then replaced by scar tissue.
Many forms of this disorder occur first as little patches of hair loss that may become larger with time. In some of the cases, hair loss may be gradual, and without any noticeable symptoms, so it may continue to develop unnoticed for a long while. In other cases, the loss of hair is accompanied by pain, burning and severe itching, and it is more rapidly progressive in this form.
It is relatively easy to tell from the look of a patch of hairless skin whether it is caused by scarring alopecia or alopecia areata. Edges of affected areas caused by the scarring disorder usually look more ragged. The hair follicle is destroyed below the surface of the skin, and thus there may not be much to see on the scalp, other than the hair loss, which is patchy and uneven. Areas affected can be clean and smooth, or they may have decreased or increased pigmentation, scaling and redness. In some cases, you may see raised blisters with pus or fluid coming from the area affected.
The visual indicators mentioned above can help with a diagnosis, but it can be very difficult to diagnose a scarring alopecia just from the hair loss pattern or the nature of the skin on the scalp. If it is suspected, the physicians will do skin biopsies, to confirm the diagnosis and also to help identify the particular form of the disorder. The physician will take a small biopsy of about two to four millimeters across, and then they examine it under a microscope. They will search for inflammation location, deep skin scar tissue and the pattern of the hair follicle destruction.
Sometimes, the earlier stages of a scarring alopecia will have inflamed cells around the follicles of hair. Researchers think that this inflammation is what causes the hair follicles' destruction and the developing of scar tissue. Dermatologists argue about whether inflammation is a viable diagnosis factor, since it does not always show up in patients.
This form of alopecia nearly always burns itself out. The patches of bald skin will stop their expansion, and any other symptoms disappear. At the last stage, dermatologists have noted that there is no inflammation around the follicles if observed in skin biopsies. The bald areas won't have any more hair follicles. Usually, the hair will not regrow, although in some few cases, it has.