What Does Scarring Alopecia Look Like

Hair loss is scary and many people experience it as they age. However, not all types of hair loss are the same. There are two main types: scarring alopecia which causes permanent damage and non-scarring alopecia which is usually reversible. Each type has different symptoms and treatment approaches.

You may have seen someone with a smooth, shiny bald patch with no hair follicle openings. That is what scarring alopecia looks like. The affected area appears inflamed with a visible change in skin texture.

In this blog post, we will cover the main aspects of scarring alopecia, from its types and causes to its signs and effective treatment options.

What Is Scarring Alopecia?

Scarring alopecia or cicatricial alopecia, is a rare condition in which fibrous tissue replaces normal tissue, forming a scar. This condition causes permanent damage to hair follicles and destroys the epithelial cells surrounding them.

Scarring alopecia occurs worldwide but is less common than other forms of alopecia, affecting almost 3% of hair loss patients. It is generally not a directly hereditary condition, though some types may have a genetic predisposition. It can affect otherwise healthy individuals.

Scarring Alopecia vs Non-Scarring Alopecia – A Comparison

Scarring alopecia permanently damages hair follicles, while non-scarring alopecia can be reversed with treatment. They have distinct appearances and treatments. It is important to understand the difference between the two to know what you are dealing with:

Features	Scarring Alopecia	Non-Scarring
Follicle Status	Permanently destroyed	Intact but dormant
Scalp Appearance	Smooth, shiny, no pore openings	Normal skin texture, visible pores
Regrowth Potential	None (permanent loss)	Possible with treatment
Common Examples	Lichen planopilaris, Lupus	Androgenetic alopecia, Alopecia areata
Treatment Goal	Stop progression, reduce inflammation	Stimulate regrowth
Surface Texture	May have scarring, color changes	Usually unchanged

Scarring alopecia is less common than non-scarring alopecia but it comes with the challenge of permanent damage and scar formation.

What Causes Scarring Alopecia?

The root cause of scarring alopecia is inflammation. A series of inflammatory responses destroy epithelial cells around hair follicles, which causes permanent damage and scar tissue formation .

Your immune system protects your body from infections and triggers inflammation to eliminate damaged cells. But in some conditions, it mistakenly attacks its own healthy cells, destroying the hair follicles beyond repair.

What Is The Difference Between Primary And Secondary Scarring Alopecia?

There are two main types of scarring alopecia:

1. Primary Cicatricial Alopecia: In this type, inflammatory cells mainly target hair follicles, directly damaging and destroying them, forming scar tissue. The primary cells that attack are lymphocytes and neutrophils.
2. Secondary Cicatricial Alopecia: In this type, the hair follicles are destroyed along with other damaged skin cells resulting in permanent hair loss. This usually occurs in severe cases of infections or burns.

Scarring Alopecia: Causes and Conditions Explained

Primary and secondary alopecia are further categorized based on their causes and how they affect hair follicles.

Category	Specific Causes	Type Of Scarring Alopecia	How It Affects Hair
Autoimmune Conditions	Frontal fibrosing alopecia, Lichen planopilaris, Discoid Lupus Erythematosus	Primary	Immune system attacks hair follicles directly
Infections	Bacterial folliculitis, Fungal infections (kerion), Severe chronic scalp infections	Primary	Pathogens trigger deep inflammation in the follicle
Physical Trauma	Radiation therapy, burns, tight hairstyles or surgery related trauma	Secondary	Direct physical damage destroys the follicle
Inflammatory Diseases	Scleroderma, Morphea, Cutaneous T-cell lymphoma	Secondary	Inflammatory conditions damage skin and nearby follicles

Scarring Alopecia Types: Appearance and Patterns

The different types of scarring alopecia either primary or secondary appear with a specific pattern. Here is what each type typically looks like:

Type	Key Appearance	Most Common In	Typical Pattern
LichenPlanopilaris	Patchy hair loss with redness, scaling	Women ages 40-60	Random patches, may spread
Frontal Fibrosing Alopecia	Receding hairline, eyebrow loss	Postmenopausal women	Progressive frontal recession
Central Centrifugal Cicatricial Alopecia	Hair loss starting at crown	Women of African descent	Spreads outward from center
Discoid Lupus Erythematosus	Round patches with scaling, scarring	Adults, any age	Well-defined circular areas
Folliculitis Decalvans	Crusting, pustules formation, presence of tufted hair	Middle-aged adults	Patchy with active infection signs

These are the key symptoms you may experience during scarring alopecia. The two most common types of primary scarring alopecia are frontal fibrosing alopecia and lichen planopilaris.

What Does Scarring Alopecia Look Like?

Scarring alopecia has a distinct visual appearance compared to non-scarring alopecia. Here are some signs that help doctors recognize it:

The Main Signs

• Shiny, smooth bald regions on scalp
• No tiny holes where hair grows from
• Skin looks polished or waxy

Color Changes

• Some spots get darker than normal
• Other spots may lighten
• Different from your usual skin color

How It Feels

• Texture may feel different to touch
• Sometimes thick and tough
• Sometimes thin and delicate

Size and Growth

• Starts as small patches
• Usually just a few centimeters at first
• Grow larger over time

The Edges

• Red and swollen if it’s still spreading
• Smooth and blended if it’s stopped growing

What Makes It Different

• No tiny pores or openings in the bald area
• This missing feature is the biggest clue, as other hair loss types still have these openings

The main sign that doctors look for is smooth, shiny bald spots with no hair holes. 

Signs & Symptoms of Scarring Alopecia

Early detection of signs and symptoms of scarring alopecia results in a better treatment approach.

Early Symptoms: These begin with changes in the scalp and gradually worsen often resulting in pain and swelling on the affected area.

What You See	What You Feel	What’s Happening
Scalp Feels Sore Or Tender	Small red patches	Hair starts thinning
Burning Or Itching That Won’t Stop	More hair falling out than normal	Small bumps under the skin
Raised Or Bumpy Areas When You Touch	Inflammation in spots	Scar tissue starting to form

Advanced Stage Signs: In the advanced stage, signs become more visible and harder to ignore with scarring and changes in scalp appearance. There is also a risk of secondary bacterial or fungal infections due to damage to the skin barrier.

Hair Loss

• Big bald patches that won’t grow back
• Smooth shiny skin of bald area
• Looks almost like plastic

Skin Changes

• No tiny holes where hair should grow from
• Thick or raised patches
• Different colors than normal skin
• Skin feels tight and hard to move

Other Problems

• Easy to get infections
• Skin can’t protect itself well anymore

Early detection of signs gives a better chance of treatment.

How Is Scarring Alopecia Diagnosed?

Your doctor will diagnose cicatricial alopecia with proper examination and tests.

These include:

1. Scalp Examination: Your doctor conducts a detailed, careful examination of your scalp to note the signs. They can use a dermatoscope (a special magnifying device) to examine the scalp and examine hair follicles closely.
2. Scalp Biopsy: It is the standard test to confirm scarring alopecia. A very small piece of scalp skin is taken for microscopic investigation. This test determines the type of inflammation and helps rule out the possibility of other diseases.
3. Blood Test: You may be asked to take a blood test to find out about the autoimmune conditions related to alopecia.

Scarring Alopecia Treatment

Treatment is challenging as it is non-reversible, but early detection can give better results. Many people with scarring alopecia see improvement with treatment.

Conventional Medical Treatments

The first goal is to reduce inflammation during treatment to prevent further hair loss. The medicines prescribed by doctors include:

1. Topical Corticosteroids: These reduce inflammation when directly applied on the affected area. 
2. Oral Corticosteroids: These are prescribed for short duration but only in severe cases.
3. Immunosuppressive Drugs: Doctors may recommend immunosuppressive drugs like methotrexate and mycophenolate for long-term control of inflammation.
4. Combination Therapy: For cicatricial alopecia treatment, doctors suggest combination therapy, as improvement takes time.
5. Intralesional Steroid Injections: These can be beneficial for some patients in small active patches.
6. Antimalarial drugs: Some patients may benefit from antimalarial drugs like hydroxychloroquine, which reduces inflammation. 
7. Hair transplantation: Doctors may perform hair transplantation in selective areas after healing.

New or Experimental Treatments

New treatments for cicatricial alopecia offer better outcomes. They include:

1. JAK Inhibitors (like tofacitinib): These new pills stop your immune system from attacking hair roots. Early tests look promising for certain types of scarring hair loss. 
2. PRP Therapy: Doctors take your blood, spins it and injects the concentrated parts into your scalp, using your own healing cells. Results are mixed – helps some people, not others. Might make hair thicker in areas that aren’t too damaged. 
3. Laser Therapy: This uses low-level light on your scalp and might help hair grow back in spots that still have some life. Evidence is still weak and only works if some hair roots are still alive. 
4. Clinical Trials: Scientists are testing new medicines all the time. Ask your dermatologist about joining studies for access to cutting-edge treatments.

New treatments are in the research phase, your doctor can recommend the best option according to your condition.

Natural Approaches (Supportive Only)

Some natural methods can help you heal faster. They support your medical treatment:

• Anti-inflammatory diet rich in omega-3 and fatty acid.
• Stress management through yoga and counseling.
• Light scalp massage in healthy areas.

These natural approaches cannot completely cure you.

Scarring Alopecia: Prevention and Early Detection Tips

We cannot completely prevent scarring alopecia. The best method is to self-examine your scalp to catch early symptoms:

Monthly Scalp Check

• Once a month, look at your scalp carefully.
• Part your hair in different spots.
• Look for red areas, flaky skin, or thinning hair.
• Take pictures of anything that looks weird.

Consult your doctor if you find anything different, like redness, scaling or unusual hair loss.

When Should You See A Doctor For Scarring Alopecia?

Immediately consult a dermatologist experienced with scarring alopecia. If you notice any symptoms, take a photo of your scalp to discuss your concerns. Look for these signs:

• Pain And Swelling: Scalp pain, redness, or puffiness that worsens.
• Weird Hair Loss: Smooth and shiny bald spots with no hair follicle openings, patches that keep getting bigger.
• Daily Life Problems: Scalp pain that stops you from normal activities, itching that drives you crazy, embarrassment about appearance, can’t sleep because of discomfort.
• Signs Of Infection: Pus-filled bumps, crusty, scabby areas, looks infected or nasty.

Scarring Alopecia Pictures

If you find any notable sign take a picture of it. Share it with us or your doctor to rule out the cause.

What triggers scarring alopecia?

The exact triggers are unknown, but inflammatory conditions that affect hair follicles or autoimmune diseases can be the cause.

How to tell if alopecia is scarring?

Scarring alopecia results in permanent bald patches, looking for smooth shiny areas with no hair follicle openings.

What is the most common form of scarring alopecia?

The most common form of scarring alopecia affects women mostly between age 40-60, it is known as lichen planopilaris.

How to stop scarring alopecia from spreading?

You can stop scarring alopecia from spreading by finding out about your signs early and starting proper medical treatment.

Can my hair grow again after scarring alopecia?

In scarring alopecia, hair does not regrow, however with early medical intervention hair loss can be reduced.

What can be mistaken for scarring alopecia? 

Regular baldness, alopecia areata or some fungal infections, the main difference is that scarring alopecia does not leave hair follicles hole.

Does stress cause scarring alopecia? 

Stress doesn’t cause it, but it can make it worse. Your immune system attacking your hair roots is the real problem.

How to live with scarring alopecia? 

Focus on treatment options, work with a good doctor, take a healthy diet, and use scarves or wigs for support .

Which vitamin deficiency causes hair loss?

Hair loss can be caused by iron deficiency or zinc and vitamin B12 but this does not cause scarring alopecia.

What autoimmune disease causes scarring alopecia?

When your immune system gets confused, it attacks your hair follicles. It happens in some diseases like discoid lupus, lichen planopilaris and frontal fibrosing alopecia.