Cicatricial alopecia, also known as, scarring alopecia, represents various types of hair loss disorders that cause permanent hair loss. Scarring alopecia causes destruction of hair follicles and replaces the follicles with scar tissue. Once hair follicles are destroyed, hair growth is not possible. Although there are different types of scarring alopecia, the common cause is inflammation of the hair follicle.

The hair follicle is located underneath the skin. Near the upper part of the follicle lives the stem cells and sebaceous glands, which secrete sebum. Once the stem cells and the sebaceous glands are destroyed, there is no way for cells to regenerate, which results in permanent hair loss. There are three common types of scarring alopecia.

Frontal Fibrosing Alopecia (FFA)

Frontal fibrosing alopecia looks like a straight narrow band of hair loss right at the front of the head. It happens around the temples and hairline. It affects postmenopausal women over the age of 50. Some people also lose eyebrow hair when they have frontal fibrosing alopecia.

The signs of frontal fibrosing alopecia

Frontal fibrosing alopecia is noticeably different under a microscope. The scalp will look shiny, discolored, red in some areas, and follicle openings will be closed. This type of hair loss can also be found in women with genetic hair loss.

What is the cause of FFA?

The cause of FFA is unknown, but it’s speculated that hormonal fluctuations could be a result since the scalp disorder affects women after menopause.

What treatments are available?

Unfortunately, there is no treatment for frontal fibrosing alopecia as of yet. Doctors may prescribe oral steroids and anti-inflammatory antibiotics. According to Dr. Singh, the 5-alpha reductase inhibitors finasteride and dutasteride have been reported to stop further hair loss in some women.

Central centrifugal cicatricial alopecia (CCCA)

Central centrifugal cicatricial alopecia is the most common form of scarring alopecia. It causes destruction of hair follicles, because inflammatory cells attack hair follicle cells. It can affect both men and women of any race, but research shows it affects African American women greater. Pressing combs, hair extensions, braids, and the length of time relaxer is left on the scalp may influence central centrifugal cicatricial alopecia.

How can you tell if you have CCCA?

Diagnosis of CCCA has to be done with the help of a biopsy from a doctor, because it can resemble other types of hair loss, such as genetic hair loss, diffuse hair loss, or alopecia areata.

Are there any signs of CCCA?

Some people may feel burning, tingling, or tenderness of the scalp. Central centrifugal alopecia may start off with a small unnoticeable bald spot on the scalp that slowly expands over time. The scalp may look shiny and feel smooth. In other cases, CCCA can take place rapidly and lead to a lot of hair loss in a shorter period of time.

Is there any treatment CCCA?

For best treatment options, I recommend going to a dermatologist who specializes in hair and scalp disorders, because it is challenging to diagnose and treat scarring alopecia. Anti-inflammatory medications are prescribed by doctors to stop or reduce lymphocytic cells from destroying the hair follicle.

Lichen Planopilaris (LPP)

Lichen planopilaris is different from other types of scarring alopecias, because it is an inflammatory autoimmune skin condition. If someone has lichen planopilaris, their immune system mistakenly attacks cells of hair follicles, replacing them with scar tissue.

What does lichen planopilaris look like?

You may notice a small patch of alopecia or multiple small areas of white hair loss. If you rub your finger against the area where you see the hair loss, the scalp feels rough. Lichen planopilaris can increase in size and be as large as the palm of your hand.

There are many types of hair loss that resemble patchy hair loss, so a biopsy is the best way to diagnose it. A person might feel pain due to the inflammation or itchy purplish bumps on the scalp.

Treatment options for lichen planopilaris

As of now, there is no treatment for lichen planopilaris. Dermatologists can recommend antihistamines to relieve itching, topical treatments, such as corticosteroid creams, to bring down the swelling, and treat bumps with prednisone shots. Lichen planopilaris goes away by itself and any treatment prescribed will help alleviate the symptoms.

The first step in diagnosing scarring alopecia is to get a scalp biopsy. It advises the doctor on the type of inflammation present, as well as how much inflammation is affecting the follicles and where the inflammation is in the hair follicle. A biopsy also helps the dermatologist determine the best therapy to use for the scarring alopecia.

What's next:

Learn more about oils that soothe the scalp, read about anti-inflammatory oils

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