Scarring alopecia is defined by irreversible damage and scarring of the hair follicle. This is one of the most challenging types of alopecia to treat. It can be caused by inflammatory fungal infections, chemical burns from relaxers, mechanical traction from tight hair styles and inflammatory scalp disorders. In general they are less common than non scarring alopecias, however several types are on the rise. They can start as an area of persistent and or intense itching/ pain on the scalp (i.e. crown- central centrifugal alopecia, frontal- frontal fibrosing alopecia, posterior- follilitis keloidalis ). There can be associated scalp redness, scaling, bumps, puss and hair shedding. Eventually a bald patch develops and the hair does not grow back. A scalp biopsy can be important for diagnosis and labs may be helpful in discovering other associated systemic disorders. These conditions are treated with topical minoxidil, topical and injection steroids, and or oral medications (anti-inflammatory, immuno-suppressant, 5 alpha reductase inhibitor pills).
Prompt diagnosis and treatment are necessary to avoid widespread and permanent hair loss.
Scarring Alopecia Classification (The North American American Hair Research Society)
Group 1: Lymphocytic
Chronic cutaneous lupus erythematosus, Lichen planopilaris, Classic lichen planopilaris, Frontal fibrosing alopecia, Graham-Little syndrome, Classic pseudopelade (Brocq), Central centrifugal alopecia, Alopecia mucinosa, Keratosis follicularis spinulosa decalvans
Group 2: Neutrophilic
Folliculitis decalvans, Dissecting cellulitis
Group 3: Mixed
Folliculitis (acne) keloidalis, Folliculitis (acne) necrotica, Erosive pustular dermatosis
Group 4: Non-specific