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Scarring Alopecia

Scarring alopecia, also known as cicatricial alopecia, is a group of hair loss disorders that occurs when hair follicles are destroyed and replaced by scar tissue.  Unlike non-scarring alopecia, such as androgenetic alopecia or telogen effluvium, the hair loss in scarring alopecia is considered to be irreversible and may not respond to hair growth products or medications.  Scarring alopecia can also cause itching, burning and pain to the scalp.

Scarring alopecia can affect people of all ages, genders, and ethnicities, and it can occur in various parts of the scalp or body.  There are several types of scarring alopecia, and each type has its own unique characteristics, causes, and treatment options.  

Here are the most common types of scarring alopecia:

  1. Central centrifugal cicatricial alopecia: CCCA is the most common type of scarring alopecia among African American women.  It typically starts at the crown of the head and spreads outward in a centrifugal pattern.  The exact cause of CCCA is unknown, but it is believed to be related to genetics, certain hair care practices, and inflammation.
  1. Lichen planopilaris:  LPP is a rare type of scarring alopecia that affects both men and women.  It is characterized by small, itchy, flat-topped bumps on the scalp that eventually lead to hair loss.  LPP is believed to be an autoimmune disorder, which means that the body’s immune system attacks the hair follicles.
  1. Frontal fibrosing alopecia:  FFA is a type of scarring alopecia that mainly affects women.  It is characterized by hair loss at the front and sides of the scalp, and it may also cause hair loss on the eyebrows and eyelashes.  FFA is believed to  be related to hormonal changes, genetics, and inflammation.
  1. Folliculitis decalvans:  FD is a rare type of scarring alopecia that mainly affects men.  It is characterized by painful, pus-filled bumps on the scalp that lead to hair loss.  FD is believed to be caused by bacterial infection.
  1. Dissecting cellulitis of the scalp:  DC is a rare and severe type of scarring alopecia that affects mostly men.  It is characterized by large, inflamed bumps on the scalp that may eventually lead to scarring and permanent hair loss.  DC is believed to be caused by bacterial infection, genetics, or immune system dysfunction.

Diagnosis of scarring alopecia typically involves an office visit to the dermatologist for a physical exam of the scalp and a biopsy to examine the affected hair follicles under a microscope.  Treatment for scarring alopecia can be challenging, as the condition is often resistant to traditional hair loss treatments.  In some cases, corticosteroids or other medication may be used to slow or stop the progression of the condition.  Early intervention is key.

While scarring alopecia can be a frustrating and challenging condition to manage, there are things that you can do to help manage your symptoms and maintain healthy hair growth.  Avoiding tight hairstyles, reducing stress, and maintaining a healthy diet and exercise routine can all help to promote healthy hair growth and reduce inflammation of the scalp.  Additionally, working with a dermatology or hair loss specialist who specializes in scarring alopecia can help you develop a treatment plan that is tailored to your specific needs and concerns.

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