Scarring
Scarring alopecias are caused by inflammation around the hair follicles. If the inflammation becomes chronic, scar tissue or ‘fibrosis’ forms and can lead to permanent or irreversible hair loss. These entities can be treated if diagnosed early. The goal of treatment is to stop the progression of the inflammation to allow the hair to regrow. However, once the scarring has begun, it becomes challenging to achieve regrowth.
If you have scarring hair loss and are interested in a hair transplant (link), a scalp biopsy must be performed that demonstrates a lack of inflammation or disease activity.
Lichen Planopilaris (LPP)
For unknown reasons, the incidence of LPP is increasing. It typically leads to tender, burning, and/or itchy areas in the scalp with redness, scaling, and bumps around the affected hair follicles.
Fibrosing Alopecia in a Patterned Distribution (FAPD)
FAPD is a form of LPP that mimics androgenetic alopecia. It is typically a more subtle presentation of LPP that often is misdiagnosed as male or female pattern hair loss.
Frontal Fibrosing Alopecia (FFA)
FFA is considered to be a variant of LPP; however, it is more commonly seen in post-menopausal women. These women experience gradual hairline recession and eyebrow loss. They can also present with bumpy, premature aged skin and discoloration.
Central Centrifugal Cicatricial Alopecia (CCCA)
CCCA predominantly people of African descent. Those with CCCA may also demonstrate features of traction alopecia. CCCA can be linked to genetic mutation in a gene encoding a hair shaft protein, as well as genes for scarring. In addition to a genetic predisposition, other factors have been associating with developing this condition. They include: tight hairstyles, relaxers, dandruff, pomade use, fibroids, diabetes, thyroid abnormalities, hyperandrogenism, and certain high blood pressure medications. CCCA can lead to tenderness and hair loss on the crown of the scalp. It left untreated, it can be a chronic, progressive condition, leading to cosmetically disfiguring balding.
Discoid Lupus Erythematosus (DLE)
DLE is an autoimmune condition that typically only affects the skin. However, rarely, these individuals can develop systemic lupus erythematosus. When DLE affects the scalp, it can cause reddish-purple or brown plaques with hair loss in the affected areas. Those with DLE may eventually develop systemic lupus erythematosus (SLE).
Tinea Capitis
Also known as ringworm of the scalp, tinea capitis can lead to thick scaly, circular patches with associated hair loss in the areas. Enlarged lymph nodes in the back of the neck may occur as well. The treatment is early detection and antifungal medication. This form of hair loss can be seen more commonly in child care givers and children of African descent.
Cutaneous Sarcoidosis of the Scalp
Sarcoidosis of the scalp often presents with red-brown, atrophic scarred plaques in the affected areas. It is a very rare form of hair loss.