Types of Hair Loss: Cicatricial Alopecia

Cicatricial or scarring alopecia is the name for a group of hair loss disorders that destroy the hair follicle and cause scar tissue to form. The scar tissue occurs below the surface of the skin so is not observable to the eye but the damage to the hair follicle can be permanent.

At first, hair loss may occur gradually and be attributed to other causes. Some people experience more severe symptoms of burning, itching, pain and other signs of inflammation such as pustules and scaling that can become progressively intolerable. Cicatricial alopecia primarily affects adults of any nationality but can also occur in children.

Cicatricial alopecia is diagnosed after a skin biopsy is taken and the skin and hair follicles are examined under a microscope. More than one skin biopsy may need to be taken. Evaluation of skin samples containing scar tissue may give information as to whether the hair lost can still grow back. Skin examined from areas of active inflammation can give information as to the specific type of cicatricial alopecia the person has.

There are different types of cicatricial alopecia, which are classified depending on what inflammatory cells, lymphocytes or neutrophils are seen under the microscope. Below are some of the main forms and treatments:

• Chronic cutaneous lupus erythematosus (CCLE): A form of lupus that only appears in the skin but systemic lupus (SLE) would still need to be checked for thorough lab tests. This type of cicatricial alopecia appears more often in women. Treatment includes both topical and injectable corticosteroids as well as other medications such as anti-malarial pills and vitamin A derivatives.

• Lichen planopilaris: The most common type that appears in Caucasians and in women more so than men. The symptoms experienced are severe itching, burning, pain and a whitish scale on the scalp. It is treated using some of the same medications as CCLE.

• Central centrifugal cicatricial alopecia (CCCA): Seen almost entirely in African American women and begins as thinning in the crown that spreads outwards.