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Scarring alopecia is a type of permanent hair loss where follicles are destroyed and scar tissue develops in their place. It is also known as cicatricial alopecia and can occur in people of all genders and ages. Doctors divide the condition into two forms, primary and secondary, depending on whether it is caused by a problem with the hair follicles, or occurs secondary to a larger health problem like cancer or systemic lupus erythematosus. This condition needs to be treated aggressively if patients want to retain as much hair as possible.
Cases of scarring alopecia usually start out small and low grade. A small bald patch starts to develop and will not be visible unless the patient has very short hair. Over time, the patch expands, and takes on a ragged, coarse appearance. The scarring alopecia will proceed across the skull, gradually destroying hair follicles along the way. If it is treated, it can be arrested, keeping the hair loss localized. A biopsy will be needed to diagnose scarring alopecia, and the sample can be examined in the lab to learn more about why it is happening.
Primary scarring alopecia is usually a result of an inflammatory process in the hair follicles, often caused by infection with bacteria or fungi. Treatment can involve medications to kill the causative organism and address the inflammation. Things like topical steroids can be applied to reduce swelling and prevent the inflammation from spreading to neighboring, healthy follicles. Once the problem is resolved, the hair loss should stop.
In secondary cases, where it is associated with an underlying issue, treatment options are variable. Addressing the cause can resolve the scarring alopecia, but not necessarily. With cancers, for example, the patient may already be in treatment and the alopecia could be the result of failed treatment or it may actually be caused by the treatment, as radiation can result in hair loss, sometimes permanently. A doctor can discuss options like treating inflammation in the scalp to see if that will help slow or stop the hair loss.
After a patient has recovered from scarring alopecia, there are a number of options to deal with the hair loss. Growing the neighboring hair out and styling it carefully may allow the patient to cover the patch. Patients might also opt to shave, or consider getting implants or wearing a wig to conceal the scarring and hair loss. Doctors can discuss the options with their patients and provide them with referrals. Patients may also find it helpful to look up alopecia awareness organizations to connect with other patients and get information about methods for addressing hair loss.