Scarring Alopecia: Why Early Diagnosis is Important?

What is scar alopecia?

Scarring alopecia is a group of hair disorders in which the hair follicle is permanently damaged as a result of inflammation and replaced by scar tissue. When the follicle is completely lost, hair may not be able to regrow in that area. Therefore, early diagnosis can be more critical in these diseases than in many other causes of hair loss.

What diseases can cause scarring alopecia?

Lichen planopilaris, frontal fibrosing alopecia, discoid lupus erythematosus, and folliculitis decalvans are prime examples. In some diseases, inflammation causes significant itching, burning, or pain, while in others, hair loss may progress more silently.

Which symptoms are important?

Burning, pain, tenderness, perifollicular redness or scaling, pustules, and progressively expanding, persistent bald patches on the scalp may suggest the possibility of scar alopecia. The disappearance of follicular openings in some areas of the scalp is also an important finding.

How is the diagnosis made?

Dermatological examination and trichoscopy are basic evaluation tools. If there is uncertainty regarding the diagnosis or disease activity, scalp biopsy may be necessary. Obtaining the biopsy from the active edge of the disease and from the correct area affects diagnostic accuracy.

What is the goal of the treatment?

The primary goal of treatment is not to regrow hair in completely scarred areas, but rather to stop active inflammation and prevent further follicle loss. The topical, intralesional, or systemic treatments used will vary depending on the underlying disease and its activity level.

Is hair transplantation possible?

Hair transplantation is not suitable for active scarring alopecia. It may be considered in selected patients after careful evaluation when the disease has remained stable for a long time and signs of inflammation have disappeared. However, the possibility of disease reactivation is not entirely zero.

When should you consult a dermatologist?

If hair loss is accompanied by pain, burning, or tenderness of the scalp

If there is redness, pustules, or marked perifollicular dandruff on the scalp

If shiny areas develop on the scalp where follicular openings have disappeared

If hair loss is progressively expanding and appears permanent

Dermatologist's Note

In scarring alopecia, time is of the essence. Once the follicle is completely damaged, recovery is limited. Therefore, the goal is not only to camouflage the existing opening, but also to prevent further permanent loss by detecting active disease early.