Cicatricial alopecia

Scar alopecia refers to a group of diseases that cause hair loss. This diagnosis puts about 3% of people suffering from alopecia. Cases of cicatricial alopecia have been documented in many countries of the world in healthy men and women of different ages.

There are a number of forms of cicatricial alopecia. These include, for example, delaminating panniculitis, eosinophilic pustular folliculitis, follicular degeneration syndrome, decolvulatory folliculitis, flat follicular lichen, Broca pseudocolus, etc. In addition, scar alopecia can be part of a larger disease, for example, chronic lupus erythematosus, which affects many organs of the body.

Despite the variety of forms, scarring alopecia has a common basis – permanent irreversible destruction of hair follicles and their replacement with scar tissue.

Most forms of this disease begin with the appearance of small areas of the scalp, devoid of vegetation, which eventually become more extensive. In some cases, hair loss occurs gradually, without visible symptoms and for a long time remains invisible. In others, on the contrary, it is accompanied by severe itching, burning, painful sensations and rapidly progressing.

Skin areas affected by alopecia scarring, usually differ from those that are formed in alopecia areata, with their rough edges. The destruction of the hair follicles occurs below the surface of the skin, so any other signs of this disease, with the exception of hair loss, is difficult to notice. Affected areas of the skin can be smooth and clean, or reddish, flaking with strengthened or weakened pigmentation, or have blisters filled with fluid or pus. These visible indicators can help in diagnosing, but can not be decisive.

Very often, if you suspect a scarring of alopecia, several skin biopsies are done to confirm the diagnosis and determine its specific shape. Biopsy requires a small element of the affected scalp (2-4 mm in diameter), which is examined under a microscope. A pathologist or dermatologist should detect the destruction of the hair follicles, scar tissue deep in the skin, the presence and location of the inflammation focus in relation to the hair follicle.

Often in the early stages of scarring alopecia around the hair follicles appear inflammation cells, which, according to many researchers, cause their destruction and development of scar tissue. However, there are also conflicting arguments based on the fact that sometimes a sample of tissue taken for biopsy from the area affected by scarring alopecia demonstrates a minor inflammatory process.

After a while, the development of cicatricial alopecia will begin to fade, and then completely cease. Hairless areas will cease to expand; inflammation, itching, burning and pain will pass. At the stage of attenuation of the disease, a biopsy usually indicates the absence of an inflammatory process on the affected areas of the scalp. Most often bald areas do not contain hair follicles, and only a few longitudinal scars that cut deep into the skin point to the places where they were once. Sometimes on the outskirts of bald areas there remains a small number of dilapidated follicles, capable of recovering.

Methods of treatment of cicatricial alopecia

Scar alopecia can cause significant damage and lead to the final loss of hair, so treatment of scarring alopecia should be quite aggressive. Its methods vary depending on the specific diagnosis. Scalp alopecia, manifested mainly in the inflammation of the hair follicles with an increase in lymphocyte levels, for example, in flat hair follicles and pseudo-pilose, is usually treated with corticosteroids in the form of local-purpose creams and injections injected into the affected area. In addition, antimalarial and isotretinoin agents can be used.

In cicatricial alopecia, accompanied by an increase in the level of neutrophils in the focus of inflammation or cell mixing, treatment necessarily includes antibiotics and isotretinoin. In this case, the use of such drugs as methotrexate, tacrolimus, cyclosporine and thalidomine is considered less traditional.

Once scar alopecia reaches its final stage of development, and within a few years the patient will not experience hair loss, bald areas can either be surgically removed if they are small, or they can be transplanted to hair follicles taken from unaffected areas.

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