Scarring Hair Loss

Scarring alopecia (also known as cicatricial alopecia) is a group of disorders where inflammation around the hair follicle  destroys the hair follicle and leads to scarring. This scarring is a shiny patch and can never regrow hair and is very difficult to transplant into.

Recognition and management of scarring alopecia is classed as a medical emergency among those who treat hair loss. If left untreated these conditions will progress and the bald patches will expand. Because the inflammation and scarring destroy the follicles (including the stem cells which reactivate the follicle after a hair falls out) medical treatment cannot reverse these conditions.

Gaining control quickly in order to stop progression is more important in scarring alopecia than in any other form of hair loss. The longer the hair loss is not treated the greater the area of permanent scarring. Treatment depends on which form of scarring alopecia the patient has.

These forms of hair loss are rare but essential to recognise. This is one of the reasons you need to see someone who can recognise these and advise the correct treatment.



This is an infection, basically a complicated boil. It is called neutrophilic because neutrophils are seen when a biopsy of an affected area is viewed under a microscope. Neutrophils are the white cells at the front line of the body’s battle against bad bacteria. The bacteria Staphylococcus aureus (which causes boils and school sores) has been cultured from some patients with folliculitis decalvans.

Antibiotics are the mainstay of treatment but, because the hair follicles are like a complicated cave system under the skin, antibiotics do not usually clear the infection, only suppress it. Long courses (months or years), multiple antibiotics, isotretinoin (the very powerful acne medication) or even excision of the affected area may be needed.

Other infective causes of hair loss are Dissecting Cellulitis and Acne Keloidalis Nuchae, both of which almost always affect black men.


This is a group of conditions where an underlying cause is the immune system attacking the hair. Treatment depends on which condition the individual has. Diagnosis may be clear after history taking and clinical examination but may require a scalp biopsy to be sure.


Frontal Fibrosing Alopecia which can easily be mistaken for Female Pattern Hair Loss

Frontal Fibrosing Alopecia.

This immune based cause of hair loss almost always affects middle aged and menopausal women. There is currently a worldwide epidemic of this condition for reasons which are unclear. It is commonly misdiagnosed as female pattern hair loss. Fastidious medical treatment will halt this condition in the majority of cases and it may be possible to transplant hair into the scarred areas once active disease settles.

Lichen Planopilaris and Pseudopelade.

These cause a patchy loss of hair which could be confused with alopecia areata. Drug treatment to halt progression is available.

Central Centrifugal Cicatricial Alopecia.

This almost exclusively affects black women and, as the name implies, spreads out from the crown. It may be that this condition is due to a combination of an immune cause and tight hairstyles such as cornrows.

Discoid Lupus Erythematosis AKA Chronic Cutaneous Lupus Erythematosis.

This is an immune condition leading to red, scaly patches on the skin and scalp which permanently scar. In ten percent of cases there is systemic involvement and kidney failure is a risk.

Other rare forms of scarring hair loss are Alopecia Mucinosa and Keratosis Folliculosis Spinulosa Decalvans.

Scarring hair loss can be effectively treated using medically proven regimens. Talk to Dr Paul about overcoming scarring hair loss today. P:(09) 360 4078