Scarring alopecia develops from hair follicle destruction due to inflammation. It can lead to scar tissue and permanent hair loss.

Scarring (cicatricial) alopecia is a rare type of hair loss that can be caused by autoimmune disorders, or by acute issues like burns or severe infections.

Like other types of alopecia, it’s thought to have an inflammatory component that targets your hair follicles and impacts hair growth. Unlike other alopecia types, scarring versions can involve scar tissue, and subsequent hair loss is likely permanent.

Learn more about scarring alopecia, including its causes, symptoms, and treatment options.

Scarring alopecia may be primary or secondary. Primary subtypes may be caused by underlying inflammation or autoimmune response, while secondary subtypes have external causes like chemical burns, severe infections, or other damage to the skin.

Primary scarring alopecia

Primary scarring alopecia targets and destroys your hair follicles due to non-external factors, such as autoimmune disorders.

Types of primary scarring alopecia include:

The most common types are frontal fibrosing alopecia and lichen planopilaris.

Secondary primary alopecia

When discussing scarring alopecia, most health care professionals are referring to primary forms. However, it’s also important to be aware of secondary subtypes.

These may be caused by external factors, such as:

Scarring alopecia is considered a rare condition worldwide, and the exact causes of primary subtypes are not known.

The effects of scarring alopecia, on the other hand, are well established. All subtypes involve inflammation that targets hair follicles, where both the underlying oil (sebaceous) glands and stem cells are destroyed. Without functioning hair follicles, new hairs cannot grow.

Also, while scarring alopecia can develop in all sexes and age groups, researchers are not sure whether this condition has a genetic component.

One type of primary scarring alopecia, central centrifugal cicatricial alopecia, is most common in females of African descent and can possibly run in families.

Possible symptoms of scarring alopecia appear on the scalp and may include:

  • scaling
  • redness
  • tenderness
  • burning
  • itching
  • pain
  • pigmentation changes
  • pustules
  • smooth bald spots without pore markings

Scarring alopecia can cause permanent hair loss once the affected hair follicles are damaged.

Other potential complications include recurring or persistent scalp symptoms.

Consider speaking with a medical professional if you’re experiencing possible symptoms of scarring alopecia, including unexplained hair loss, bald spots, and scalp inflammation. They can help accurately diagnose the underlying cause.

A dermatologist can identify scarring alopecia. This is a type of doctor who specializes in diagnosing and treating conditions of the hair, skin, and nails.

A dermatologist will diagnose scarring alopecia with a combination of the following methods:

  • Scalp biopsy: Considered the first step in diagnosing scarring alopecia, the process involves a punch biopsy of the scalp. The sample is then sent to a lab to help determine the presence inflammation and type, as well as the degree of hair follicle damage.
  • Physical exam: A dermatologist will look for signs, such as patches of smooth baldness, pustules, and inflammation. They will also ask you about your history of symptoms, such as burning, tenderness, and hair loss.
  • Hair pull test: This test involves pulling out samples of your hair to see which areas of your scalp may be affected by this type of alopecia. The hairs are also examined under a microscope to determine whether they’re in the growing (anagen) or resting (telogen) phases. A loss of anagen hairs could confirm scarring alopecia.
  • Personal health history: This includes the age you started noticing hair loss, as well as your medical history, current diet, and medications you take.

Treatment for scarring alopecia focuses on stopping inflammation that’s causing disease activity, so remaining healthy hair follicles may be spared. Subsequently, treatment can also reduce scalp symptoms.

There are a variety of medications used in the treatment of scarring alopecia, and some may vary based on the subtype you have. Possible options include:

Additionally, a dermatologist may recommend over-the-counter hair growth treatments, such as minoxidil (Rogaine). While these topical treatments can take at least 4 months to work, they may help preserve healthy hair follicles before they get permanently damaged.

Optional hair restoration surgery may be an option once disease activity stops for at least 1 to 2 years.

Without treatment, the destruction of hair follicles and subsequent hair loss can continue for life. Some people may experience rapid disease progression with extensive hair loss. Others might experience minimal hair loss with a more gradual progression.

In all, most people who are diagnosed with scarring alopecia and receive treatment may still have enough hairs in the affected areas of the scalp to cover any areas of baldness.

There’s currently no known preventive measures for primary scarring alopecia.

In the case of secondary subtypes, it maybe possible to prevent some underlying causes, such as burns. Infections, cancer treatments, and other external factors may be more difficult to avoid.

It’s also important to know that not everyone who experiences infections or burns will develop scarring alopecia.

Consider speaking with a dermatologist about the following frequently asked questions:

Can hair grow back from scarring alopecia?

Unlike other types of hair loss that may be corrected, scarring alopecia permanently damages your hair follicles. Once the damage is done, the affected hair follicles will no longer produce new hairs.

What is the difference between scarring alopecia and non-scarring alopecia?

Both scarring and non-scarring alopecia can affect your hair follicles and lead to hair loss. The big difference is that hair follicle damage and hair loss in scarring alopecia is permanent. Scarring forms are also less common than non-scarring.

In non-scarring alopecia, hair may possibly grow back. Examples of non-scarring alopecia include alopecia areata, telogen effluvium, and androgenetic alopecia.

Can you treat scarring alopecia naturally?

There are no known natural treatments that work for scarring alopecia.

However, in addition to medical treatments, a dermatologist might recommend gentle shampoos to help decrease scalp irritation. Optional hats, scarves, and wigs are also safe to wear, if you want to do so.

Will your hair regrow after scarring alopecia?

The goal of scarring alopecia treatment is to help save healthy hair follicles from permanent damage so they can continue producing hairs. Hair that has been lost from damaged follicles will not regrow.

Scarring alopecia is a type of hair loss that may be caused by primary factors like autoimmune disease or secondary factors like injuries and infections. This type of alopecia is distinguished by permanent hair follicle damage that can stop hair growth.

While permanent, scarring alopecia is treatable. You may also be able to stop further hair loss with an early diagnosis.

If you are concerned about hair loss along with other possible symptoms of scarring alopecia, consider reaching out to a dermatologist for help.