Scarring alopecia

What is scarring alopecia?

Scarring alopecia is a localized alopecia characterized by an irreversible destruction of hair follicles in the affected area.

There are many causes of scarring alopecia:

• It can be secondary to an inflammatory pathology of the scalp, whether it is linked to an infection (bacterial, viral or by microscopic fungi), or the consequence of a more general inflammatory pathology of the skin (dermatosis).
• Accidents, such as trauma or burns, can cause scarring alopecia of the scalp
• Radiotherapy to the head and neck as part of cancer treatment causes scarring alopecia in some patients.

Symptoms of scarring alopecia

Scarring alopecia is characterized by the appearance of an area of scarred skin, smooth and shiny, on which no hair grows back. The shape and size of the scar varies depending on the cause of the scarring alopecia.

Unlike androgenetic alopecia, scarring alopecia does not go through a phase of progressive hair miniaturization.

A specific form of scarring alopecia is common in African-American women: central centrifugal scarring alopecia. Its origin remains difficult to explain. Hair care practices for frizzy hair with repeated braiding, weaving, and application of straightening products, seem to be triggering factors. Alopecia appears characteristically on the top of the head and progresses in a symmetrical and centrifugal manner (hence its name).

How to recognize scarring alopecia

Scarring alopecia is characterized by a loss of hair on one or more areas of the scalp, of varying degrees of severity depending on the cause, and in various forms.

Red patches are found on the scalp in the case of an inflammatory origin. The hair follicle is destroyed and replaced by a fibrous scar, which gives the skin a smooth and shiny appearance.

Central centrifugal scarring alopecia has the same distribution as female androgenetic alopecia. The absence of miniaturized hair and hair follicle orifices on the alopecic area helps guide the diagnosis.

Treatment for scarring alopecia

If the inflammation is diagnosed and treated quickly, partial regrowth can be obtained in the best cases.

When the inflammation is too severe or when the origin is accidental, hair transplantation remains the only treatment option to regrow hair in the area affected by scarring alopecia. An important criterion for the feasibility of this transplant is that the donor area of the implants, in the neck, has been spared from scarring alopecia. Hair implantation allows the correction of alopecia permanently and with a natural appearance.

Camouflage techniques, such as wearing a wig, headband, turban or pigmentation with semi-permanent micro-tattooing, are also valuable options to cope with scarring alopecia and improve quality of life.