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Scarring (Cicatricial) Alopecia

Primary Cicatricial Alopecia

What is Cicatricial Alopecia or Scarring Alopecia?

Scarring alopecia is a group of rare hair disorders in which the follicles are permanently destroyed and replaced with a scar tissue, leaving patchy hair loss. The disease may go unnoticed for years or may quickly advance within a few months. Some of the symptoms are hair loss, redness, dandruffs and acne in the affected area. In some rapidly advancing cases, itching, burning and pain may be experienced. The disease is not infectious neither is it hereditary; it affects both men and women of any age.

The disease is categorized in two different types:

Primary Cicatricial Alopecia: the disease directly destroys hair follicles. The classification of primary cicatricial alopecia is controversial. Most of these diseases demonstrate some overlap in clinical and histologic features, blurring the distinction between disorders. In 2001, a North American Hair Research Society workshop developed a provisional classification for primary cicatricial alopecias :

Group 1: Lymphocytic
  • Discoid lesions of lupus erythematosus
  • Lichen planopilaris
    • Classic LPP
    • Frontal fibrosing alopecia
    • Graham Little syndrome
  • Classic pseudopelade (Brocq’s alopecia is the authors’ preferred term)
  • Central centrifugal cicatricial alopecia
  • Alopecia mucinosa
  • Keratosis follicularis spinulosa decalvans
  • Graft-versus-host disease
Group 2: Leutrophilic
  • Folliculitis decalvans
  • Dissecting cellulitis
Group 3: Mixed
  • Acne keloidalis
  • Acne necrotica
  • Erosive pustular dermatosis
Group 4: Nonspecific
  • Cicatricial pemphigoid
  • Busulfan-induced alopecia

Secondary Cicatricial Alopecia

The follicles are indirectly destroyed by factors such as deep burns, radiation dermatitis, cutaneous malignancies, cutaneous sarcoidosis, morphea, necrobiosis, lipoidica, and certain chronic infections such as cutaneous tuberculosis.

Are there any other diseases that come with cicatricial alopecia?

No there aren’t any diseases that come along with it. In fact, it affects healthy men and women.

How is cicatricial alopecia diagnosed?

Scalp biopsy is important for diagnosis of cicatricial alopecia. Specimens should be at least 4 mm in diameter and extend into the fat.

Performing a scalp biopsy may be helpful not only in establishing a diagnosis but also in assessing the degree of inflammation and injury to the stem cell region.

What is the treatment of cicatricial alopecia?

The main goal in treating primary cicatricial alopecia is to stop the inflammation and further progression of the disease . Treatment options are topical steroids, intralesional triamcinolone acetonide , retinoids, hydroxychloroquine, and mycophenolate. If hair loss is extensive or disfiguring, hair restoration is another treatment option. No disease activity should occur on the scalp for at least 1 year after therapy after which hair restoration surgery can begin. The patient has to be warned about a possible limited graft survival and disease recurrence.

For secondary cicatricial alopecia treatment: hair restoration surgery, including hair transplantation and scalp reduction, can be an option.

Primary Cicatricial Alopecia

Hair Loss

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