Scarring Alopecia
Scarring alopecia encompasses various different forms of alopecia that lead to permanent hair loss due to destruction of the hair follicles, including central centrifugal cicatricial alopecia (CCCA), lichen planopilaris, cicatricial alopecia and frontal fibrosing alopecia.
Frontal fibrosing alopecia affects the hair margin at the front of the scalp, gradually destroying the hair follicles and leading to visible scarring and hairline recession.
It is closely related to lichen planopilaris, which occurs when a common inflammatory skin condition known as lichen planus affects areas of the scalp.
Once the follicles are damaged, they are replaced with scar tissue, meaning hair cannot regrow in the affected areas. Early diagnosis is therefore essential to prevent further progression.
At The London Skin and Hair Clinic, Consultant Dermatologists specialise in diagnosing scarring alopecia and related hair loss conditions. Patients seeking a hair loss dermatologist in London can access expert assessment and personalised management plans.
Scarring alopecia encompasses central centrifugal cicatricial alopecia (CCCA), lichen planopilaris, cicatricial alopecia and frontal fibrosing alopecia.
Diagnosis may involve physical examination with a Dermatascope, hair pull tests, blood tests to rule out underlying medical conditions, and in some cases a scalp biopsy.
As this condition can result in permanent hair loss, early treatment is important.
Hair transplants may be considered where the condition has been stabilised.
What causes Scarring Alopecia?
The causes of scarring alopecia vary depending on the specific condition, but many forms are linked to inflammation and immune system activity.
Lichen planopilaris is not an inherited condition, and as yet its cause is unknown. It is thought to be linked to the body’s immune system, where T-lymphocyte white blood cells attack the hair follicles, leading to inflammation and damage.
Frontal fibrosing alopecia is thought to be triggered in most women by the menopause, suggesting a hormonal influence, although the exact mechanism is not fully understood.
In many cases, scarring alopecia develops without a clearly identifiable trigger.
Who is at risk of Scarring Alopecia?
Both frontal fibrosing alopecia and lichen planopilaris are more common in women than in men. They mostly affect Caucasian females over the age of 40.
Due to its association with hormonal changes, frontal fibrosing alopecia mostly affects women in their mid-40s and above.
Some patients may also have a history of autoimmune or inflammatory skin conditions, which can increase susceptibility.
What are the symptoms of Scarring Alopecia?
The most obvious symptom of lichen planopilaris is an itchy scalp which may also become inflamed and tender. This usually affects the top of the scalp and the crown of the head.
The scalp may appear red around the base of the hair, and have a rough or scaly texture where the hair follicles have been affected. Hair loss often occurs in patches, and over time these areas may become smooth and shiny due to permanent follicle loss.
On rare occasions, facial and body hair can also be affected.
Frontal fibrosing alopecia is similar in nature, but begins with a slow band-like recession from the front hairline and sometimes the sides of the scalp. It can also lead to hair loss of the eyebrows.
Images of Scarring Alopecia
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How does a dermatologist diagnose Scarring Alopecia?
Early diagnosis is important to help halt the progression of the condition. There may be other hair loss conditions present, so a Dermatologist who specialises in hair and scalp disorders will aim to identify all contributing factors.
Diagnosis may involve physical examination with a dermatoscope, hair pull tests, and blood tests to rule out underlying medical conditions.
In many cases, a scalp biopsy is required to confirm the diagnosis and determine the specific type of scarring alopecia. A specialist pathologist experienced in hair disorders will assess the biopsy samples, which are typically taken from areas showing active inflammation or scarring.
How does a dermatologist treat Scarring Alopecia?
As this condition can result in permanent hair loss, early treatment is important. The aim of treatment is to slow or stop progression rather than to regrow lost hair.
The Dermatologist may prescribe topical treatments such as creams and gels, as well as oral medications. Steroid creams, injections or tablets may be used to reduce inflammation, tenderness and itching.
Blood tests may be required to monitor treatment safely. In some cases, medications such as hydroxychloroquine or other immunosuppressive drugs may be prescribed.
Response to treatment varies, and ongoing monitoring is often required to assess disease activity and adjust management accordingly.
Hair transplants may be considered where the condition has been stabilised.