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Alopecia cicatricata (also known as cicatricial alopecia or scarring alopecia) is a type of hair loss condition characterized by the destruction of hair follicles and the replacement of these follicles with scar tissue. This type of hair loss is permanent and can result in complete baldness of the affected area.

There are several different types of alopecia cicatricata, including:

Central centrifugal cicatricial alopecia (CCCA): This is the most common type of cicatricial alopecia, affecting mainly African American women. It typically starts as a patch of hair loss in the center of the scalp and spreads outwards, leading to the formation of a circular bald patch.
Folliculitis decalvans: This type of cicatricial alopecia is characterized by the inflammation and destruction of hair follicles, leading to scarring and permanent hair loss. It often begins as small, red, painful pimple-like eruptions around hair follicles and can progress to widespread baldness.
Lichen planopilaris (LPP): This type of cicatricial alopecia affects mainly women and causes inflammation and destruction of hair follicles, leading to scarring and permanent hair loss. It often presents as patches of hair loss, usually on the crown of the scalp, and can be associated with itching and burning sensations.
Frontal fibrosing alopecia (FFA): This type of cicatricial alopecia affects mainly postmenopausal women and is characterized by the progressive hair loss and scarring of the frontal hairline, leading to a distinctive “peaked” appearance.
Discoid lupus erythematosus (DLE): This is a type of autoimmune disorder that can cause scarring and permanent hair loss. It often presents as coin-shaped, red, scaly patches of hair loss, most commonly on the scalp, but also on other areas of the body.
Traction alopecia: This type of cicatricial alopecia is caused by tight hairstyles that pull on hair follicles, leading to scarring and permanent hair loss. It is most commonly seen in people who wear tight braids, cornrows, or weaves.

Causes

The exact cause of alopecia cicatrisata is unknown, but there are several factors that are believed to contribute to its development.

Genetics: There is evidence that genetics play a role in the development of alopecia cicatrisata. Individuals who have a family history of autoimmune conditions or alopecia are more likely to develop the condition.
Immune system dysfunction: Alopecia cicatrisata is an autoimmune condition, meaning that the immune system attacks healthy hair follicles, leading to hair loss and scarring. In some cases, the immune system mistakenly identifies hair follicles as foreign invaders and attacks them.
Hormonal factors: Hormonal imbalances, such as those seen in conditions like polycystic ovary syndrome (PCOS) or hypothyroidism, have been linked to the development of alopecia cicatrisata. These imbalances can cause changes in the growth and maintenance of hair follicles, leading to hair loss.
Inflammation: Chronic inflammation can also contribute to the development of alopecia cicatrisata. Inflammation can damage hair follicles and lead to scarring, resulting in permanent hair loss.
Trauma: Physical trauma to the scalp, such as from tight hairstyles or chemical treatments, can also contribute to the development of alopecia cicatrisata. Trauma can cause inflammation and scarring, leading to permanent hair loss.
Infections: Certain infections, such as fungal infections of the scalp, can also contribute to the development of alopecia cicatrisata. These infections can cause inflammation and scarring, leading to permanent hair loss.
Medications: Certain medications, such as those used to treat cancer, can also contribute to the development of alopecia cicatrisata. These medications can cause hair loss and scarring, leading to permanent hair loss.
Age: Alopecia cicatrisata can occur at any age, but it is most common in individuals over the age of 40. As individuals age, their hair follicles may become less resilient, making them more susceptible to damage and scarring.

The exact mechanisms by which these factors contribute to the development of alopecia cicatrisata are not well understood. However, it is believed that a combination of genetic and environmental factors interact to trigger the immune system to attack hair follicles, leading to scarring and permanent hair loss.

Symptoms

This condition is considered a chronic autoimmune disorder, which means that the immune system mistakenly attacks healthy tissues in the body, including the hair follicles. In this case, the immune system attacks the hair follicles, causing inflammation and scarring, leading to permanent hair loss.

The following are the main symptoms of alopecia cicatrisata:

Hair loss: The primary symptom of alopecia cicatrisata is hair loss, which typically starts as small, circular patches of hair loss on the scalp. Over time, these patches can become larger and merge with each other, resulting in extensive hair loss. The hair loss is usually permanent and the hair follicles are destroyed, so the hair will not regrow in the affected areas.
Scalp itching: Some people with alopecia cicatrisata experience itching on the scalp, which can be mild to severe in nature. This itching can be accompanied by redness, scaling, and soreness.
Scalp scaling: Some people with alopecia cicatrisata experience scaling on the scalp, which can be accompanied by itching and redness. The scaling is a result of the immune system attacking the hair follicles, causing inflammation and scarring.
Scalp redness: People with alopecia cicatrisata may experience redness on the scalp, which can be accompanied by itching and scaling. The redness is a result of the inflammation caused by the immune system attacking the hair follicles.
Nail changes: Some people with alopecia cicatrisata experience changes in their nails, such as ridging, pitting, or brittle nails. These changes can be a sign of a more widespread autoimmune condition.
Eyebrow and eyelash loss: In some cases, people with alopecia cicatrisata may also experience hair loss in other areas of the body, such as the eyebrows and eyelashes. This can result in a loss of facial hair and a more noticeable bald spot on the scalp.
Pain: In some cases, people with alopecia cicatrisata may experience pain in the affected areas. This pain can be a result of the inflammation caused by the immune system attacking the hair follicles.

It is important to note that not all people with alopecia cicatrisata will experience all of these symptoms, and the symptoms can vary in severity from person to person.

Diagnosis

Diagnosis of alopecia cicatrisata typically involves a combination of clinical examination and laboratory tests. The following is a list of the most common diagnostic procedures and tests used to identify and evaluate the condition:

Clinical Examination: A dermatologist will typically start by conducting a thorough physical examination of the scalp, including examination of the skin, hair, and hair follicles. They will look for signs of inflammation, scarring, and any other physical abnormalities that may suggest the presence of alopecia cicatrisata.
Trichoscopy: Trichoscopy is a non-invasive diagnostic tool that allows the dermatologist to examine the hair and scalp using a specialized microscope called a dermatoscope. This test allows the dermatologist to see the hair shafts, follicles, and surrounding skin in great detail, helping to identify any signs of hair loss or damage.
Scalp Biopsy: A scalp biopsy is a procedure in which a small piece of skin and hair is removed from the scalp and examined under a microscope. This test can provide important information about the extent and severity of hair follicle damage and is often used to confirm a diagnosis of alopecia cicatrisata.
Blood Tests: Blood tests can be used to look for underlying autoimmune diseases or infections that may be contributing to the hair loss. Tests may include complete blood count (CBC), erythrocyte sedimentation rate (ESR), antinuclear antibody (ANA) test, and other autoimmune markers.
Skin Tests: Skin tests, such as a skin punch biopsy or a skin scraping test, may be performed to identify any underlying skin conditions that may be contributing to the hair loss.
Imaging Tests: Imaging tests, such as CT scans or MRI, may be used to identify any underlying conditions or abnormalities in the scalp or neck that may be causing the hair loss.

Once a diagnosis of alopecia cicatrisata has been confirmed, the dermatologist will work with the patient to develop a treatment plan. This may involve a combination of medical, surgical, and cosmetic treatments.

Medical treatments for alopecia cicatrisata may include the use of topical or oral medications, such as corticosteroids, to reduce inflammation and promote hair growth. Topical minoxidil may also be used to stimulate hair growth.

Treatment

While there is no cure for alopecia cicatrisata, there are several treatments that can help to manage the symptoms and slow the progression of the condition.

Topical Minoxidil: Minoxidil is a medication that is applied directly to the scalp. It is believed to work by increasing blood flow to the hair follicles and by preventing the progression of hair loss. Minoxidil is available over-the-counter in a 2% or 5% solution. Higher strengths are available by prescription. Topical Minoxidil is a safe and effective treatment for alopecia cicatrisata, and it has been shown to slow the progression of hair loss and promote new hair growth in some cases.
Corticosteroids: Corticosteroids are medications that are used to reduce inflammation. They are often used to treat autoimmune conditions, including alopecia cicatrisata. Corticosteroids can be applied topically to the scalp, or they can be taken orally or as an injection. Topical corticosteroids are often used to treat mild cases of alopecia cicatrisata, while more severe cases may require oral or injected corticosteroids. Corticosteroids can be effective in reducing the inflammation and slowing the progression of hair loss, but they can also have side effects, including thinning of the skin, acne, and weight gain.
Topical Anthralin: Anthralin is a medication that is applied directly to the scalp. It is believed to work by suppressing the immune system and reducing inflammation. Anthralin is a safe and effective treatment for alopecia cicatrisata, and it has been shown to slow the progression of hair loss and promote new hair growth in some cases.
Topical Calcineurin Inhibitors: Calcineurin inhibitors are medications that are used to suppress the immune system. They are often used to treat autoimmune conditions, including alopecia cicatrisata. Topical calcineurin inhibitors are applied directly to the scalp, and they have been shown to be effective in reducing inflammation and slowing the progression of hair loss.
Immune Therapy: Immune therapy involves altering the immune system in order to reduce its attack on the hair follicles. This can be achieved through the use of immunosuppressive medications or immunomodulatory agents. Immune therapy is often used in severe cases of alopecia cicatrisata that are unresponsive to other treatments. It is a relatively new and experimental treatment, and more research is needed to determine its effectiveness and safety.
Hair transplantation: Hair transplantation is a surgical procedure that involves transplanting hair follicles from one area of the scalp to another. This can be an effective treatment for alopecia cicatrisata in cases where there are areas of the scalp with healthy hair growth. Hair transplantation is a permanent solution to hair loss, and it can result in natural-looking hair growth.
Wigs and hairpieces: Wigs and hairpieces can be used to cover the areas of the scalp affected by alopecia cicatrisata. This can be a good option for those who do not want to undergo surgical procedures or who do not respond.
Immunosuppressive drugs – Immunosuppressive drugs are medications that suppress the immune system. They are sometimes used to treat alopecia cicatrisata, as they can help slow down the progression of hair loss. The most commonly prescribed immunosuppressive drugs for alopecia cicatrisata are methotrexate, azathioprine, and cyclosporine.
Platelet-rich plasma (PRP) – Platelet-rich plasma (PRP) is a treatment that involves injecting a concentrated mixture of platelets and plasma into the scalp. The platelets contain growth factors that can help promote hair growth and slow down the progression of hair loss. PRP is thought to work by stimulating the hair follicles and promoting the growth of new hair
Wigs and hairpieces – Wigs and hairpieces can be a good option for those with alopecia cicatrisata who want to cover up their hair loss. Wigs and hairpieces are available in a variety of styles and colors, and they can be a good alternative to hair transplantation.
Hair transplantation – Hair transplantation is a surgical procedure that involves transplanting hair from one part of the scalp to another. Hair transplantation can be a good option for those with alopecia cicatrisata who want to restore their hairline or improve the appearance of their scalp. However, hair transplantation is a complex and expensive procedure, and it is not suitable for everyone.
Scalp micro pigmentation – Scalp micro pigmentation is a cosmetic procedure that involves tattooing the scalp with a pigment that resembles the color of hair. Scalp micro-pigmentation can be a good option for those with alopecia cicatrisata who want to improve the appearance of their scalp.

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