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Scarring Alopecias

Scarring Alopecias are less common but certainly not rare. There are many different names that are associated with this type of hair loss including: lichen planopilaris, discoid lupus, pseudopelade, central centrifugal cicatricial alopecia, follicular degeneration syndrome, frontal fibrosing alopecia, etc.  Most of them (with the exception of discoid lupus) may all be related to the same underlying process but they have slightly different clinical presentations with or without the presence of active inflammation, occurring in different areas of the scalp, etc. Early identification of this form of hair loss is important since progressive scarring of hair follicles can occur and once a hair follicle is scarred it can no longer grow hair.  Therefore, it is important to arrest the progression of this hair loss process to preserve viable follicles.  There is no treatment to make a scarred hair follicle ‘come to life’ again so treatment is aimed at preventing disease progression until the process ‘burn’s out’ on its own.  Time to ‘burn out’ is patient specific and can last for months to years.  Later reactivation of activity can occur.

People with scarring alopecia most often are healthy.  New research findings suggest that the cause of this hair loss may lie with an abnormal gene that regulates inflammation and fat metabolism of the hair follicle.

Treatment: Treatment of scarring alopecia involves the use of topical steroids and other anti-inflammatory medications, cortisone injections, oral antibiotics that have anti-inflammatory properties, plaquenil, and various other systemic medications that aim to decrease inflammation at the level of the hair follicle.  Ultimately, if there is no inflammation or progression of hair loss for a period of time, often after one year, hair transplantation, in the hands of an experienced and skilled hair transplant surgeon may be possible with the caveat that this transplanted hair may reactivate the process once again and be lost.