Scarring Hair Loss (Cicatricial alopecia)

Hair loss of a different flavor

Mild Cicatricial Alopecia

Cicatricial alopecia is not a diagnosis anyone wants to hear when they are experiencing hair loss – particularly since it is not common and thus scarier for being unknown.  This should not be the case.  A little information can go a long way towards helping a patient understand what might be causing their hair loss and decide on the best treatment options.

In the first place, cicatricial alopecia is pronounced “sick-A-tri-SHULL  eh-lo-PEE-shuh” and is used by doctors interchangeably with the term “scarring alopecia.”  Neither of these involves scar formation the way most people think about it – just that sometimes the skin in the area of hair loss looks very smooth, like a scar.  Hair loss in this category comes in all different types and many of them are rare forms of hair loss that can sometimes become permanent, especially if they are not treated promptly and aggressively.

Since these types of hair loss are usually slowly progressive, you often find that patients will be complacent and not seek a diagnosis or treatment early.  This is a mistake since usually the hair in these areas can be saved.  Early and ongoing effort is worth it!


It is only recently (about 2001) that doctors have devised a system for diagnosing these types of hair loss.  Different classifications have been proposed that have to do with how the hair looks and what cell types are seen under a microscope.  For instance, the two main types are “lymphocytic” and “neutrophilic” with “mixed” and “nonspecific” types rounding out the categories.

In order to get a diagnosis, a biopsy is usually necessary.  This is not as scary as it sounds and only involves a pinprick with a tiny bit (or sometimes two bits) of tissue being removed.  Some doctors will place a stitch in the area if it is a cosmetically significant spot, but it is not strictly necessary.  Likewise, blood tests might be done to rule out other treatable forms of hair loss (like hair loss from thyroid problems or lupus).  Either way, the doctors who specialize in this are either dermatologists or, more rarely, hair doctors/surgeons.

Why is going on?

Recent research has suggested that what is happening in these various cicatricial alopecias is a problem with lipid metabolism.  In other words, your cells usually export fat-like substances because they will be toxic if they build up.  It the system that accomplishes this is damaged, the lipids accumulate and cause inflammation that damages the hair cells.

Another part of the puzzle is that many times the body’s own immune system seems to be targeting itself.  Like “friendly fire,” it destroys its own tissues.  Again, many differing types of cicatricial alopecias exist, so it is likely that one reason does not fit the cause of all these hair loss maladies, but this new information is exciting the world of hair medicine and may provide some diagnostic and therapeutic advances in the near future.

What treatments are available?

Many different treatments are available depending on what sort of cicatricial alopecia a patient ends up being diagnosed with.  Most of these disorders will wax and wane in their course – that is – they speed up and slow down intermittently over months to years.  Whatever medical treatment is tried is likely to take months to show improvement so patients should not give up!  Also, hair transplant is a possibility once the area has “calmed down.”  Many hair surgeons will consider at least testing some hair grafts in an area affected by a scarring alopecia, and some early successes have encouraged the whole hair community.  As a general rule, plan on waiting two –three years before attempting a transplant.  If it is done when the area is active, the grafts may be destroyed just as the original hair was.

Further, since hair loss can be so emotional, it is also important for patients to plug themselves into a support network for the long haul.  Many such organizations exist (the for example) and these communities provide both information and comfort for all types of hair loss sufferers.

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