Cicatricial alopecia, more commonly called scarring alopecia, is a rare form of hair loss that permanently damages hair follicles. Instead of simply shedding hair, the condition destroys the follicle itself and replaces it with scar tissue. Once that happens, the hair in that area cannot grow back.
It can look similar to other types of hair loss in the beginning, so scarring alopecia is sometimes overlooked. The earlier it is identified, the better the chances of stopping further damage.
What Is the Cause of Cicatricial Alopecia?
Cicatricial alopecia is caused by inflammation that targets the hair follicle. When that inflammation damages the follicle’s stem cells, the follicle cannot repair itself. Over time, scar tissue forms in its place.
In primary cicatricial alopecia, inflammation directly attacks the follicle. In secondary cases, something else (like a severe infection, burn, radiation treatment, or physical trauma) damages the scalp and scarring follows. The exact cause depends on the specific subtype.
What Does Cicatricial Alopecia Look Like?
Scarring alopecia usually starts as small patches of thinning or hair loss that slowly expand. The affected skin may look smooth or shiny, and you might notice the tiny openings where hairs normally grow are no longer visible.
Some people experience symptoms like itching, tenderness, burning, redness, or scaling before noticeable hair loss occurs. Others may not have much discomfort at all.
How Is Cicatricial Alopecia Treated?
Treatment focuses on calming the inflammation to prevent additional follicles from being destroyed. It is less about regrowing lost hair and more about protecting what is still there. Doctors often prescribe anti-inflammatory medications. These may include topical or injected corticosteroids, oral medications such as hydroxychloroquine, antibiotics with anti-inflammatory effects, or other immune-modulating treatments depending on the diagnosis.
Because there are several subtypes, treatment is not one-size-fits-all. A scalp biopsy is often needed to determine exactly what type of scarring alopecia is present.
Can Hair Grow Back After Scarring Alopecia?
If a follicle has already been replaced by scar tissue, it will not grow hair again. That is why early treatment matters so much. For people whose condition has been stable for a long time, hair transplantation may be an option, though results vary and require careful evaluation.
Is Cicatricial Alopecia Reversible?
In most cases, no. Once scarring occurs, it is permanent. The goal of treatment is to stop progression, not reverse damage that has already happened. That said, many people are able to stabilize the condition with proper medical care and prevent further spread.
What Triggers Scarring Alopecia?
Triggers depend on the subtype. Autoimmune reactions, chronic inflammatory scalp disorders, severe infections, chemical injuries, radiation exposure, and long-term tension from tight hairstyles can all play a role. Genetics may increase susceptibility, but in others, the cause remains uncertain.
How Can You Tell The Difference Between Scarring and Non-scarring Alopecia?
The key difference is whether the follicle is still alive. In non-scarring forms of hair loss, the follicle remains intact, meaning hair can potentially grow back. With scarring alopecia, follicular openings disappear. The skin may appear smooth, shiny, or slightly firm.
Is Cicatricial Alopecia an Autoimmune Disorder?
Some types are thought to be autoimmune, meaning the immune system mistakenly attacks the hair follicle. Others are caused by infections, injury, or different inflammatory processes. Cicatricial alopecia is not a single disease but a category of disorders that share one defining feature: permanent follicle destruction. If you are noticing ongoing scalp inflammation or unexplained patchy hair loss, it is worth getting evaluated.
PNW Hair Restoration Can Help You Diagnose & Treat A Wide Range of Hair Loss Causes
Cicatricial alopecia is a rare form of hair loss, but hair thinning and loss affects millions with a wide range of causes and contributing factors. If you are concerned about thinning hair or think you may be suffering from alopecia, the team at PNW Hair Restoration can help you determine your hair health issues and find a customized treatment plan for your needs. Contact us today to schedule a consultation.
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