What is Scarring Alopecia?
Scarring alopecia encompasses various different forms of alopecia that lead to scarring 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 destroying the hair follicles and leaving a form of obvious scarring.
It is closely related to lichen planopilaris which occurs when a common skin disease known as lichen planus is present on an area growing hair.
What are the symptoms of Scarring Alopecia?
The most obvious symptom of lichen planopilaris is an incredibly 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 texture where the hair follicles have been blocked. It often occurs in patches, although the areas where the hair has been destroyed can often feel smooth and shiny. On rare occasion’s 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 side of the scalp. It can also lead to other hair loss including eyebrows.
What causes Scarring Alopecia?
Lichen planopilaris is not an inherited condition, and as yet its cause is unknown. It may be linked to the body’s immune system, as it is known that the T-lymphocyte white blood cell is linked to the condition. When the hair loses its protection from the immune system, the immune system starts to attack the hair follicle. However it is not yet known what triggers this.
Frontal fibrosing alopecia is thought to be triggered in most women by the menopause.
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 it being triggered by the menopause, frontal fibrosing alopecia mostly affects women in their mid 40s upwards.
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 and so a Dermatologist who specializes in hair loss and scalp conditions will look to identify all the conditions causing the hair loss.
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. A specialist pathologist who is experienced in hair loss and scalp conditions will assess the skin biopsy and typically 2-3 samples are required from the scalp at areas where scarring is visible.
How does a dermatologist treat Scarring Alopecia?
As this condition can result in permanent hair loss, early treatment is important. This condition can be difficult to treat and not all patients respond to treatment.
The Dermatologist may prescribe topical medication, such as creams and gels, and oral medication. Steroid creams, injections or pills may also be prescribed to reduce the tenderness and itching. Blood tests may be required in order to minimise side effects. In some cases the Dermatologist may prescribe low dose hydroxychloroquine or immunosuppressive drugs.
Hair transplants may be considered where the condition has been stabilised.