Cicatricial Alopecia

Cicatricial alopecia, also known as scarring alopecia, is a group of hair loss disorders that result in permanent hair loss due to scarring of the hair follicles. There are several subtypes of cicatricial alopecia, each with different causes and symptoms. Cicatricial alopecia, also known as scarring alopecia, is a type of hair loss that results in permanent hair loss due to damage to the hair follicles. The hair follicles are replaced by scar tissue, which prevents new hair growth. There are several causes of cicatricial alopecia, including autoimmune diseases, infections, and physical damage to the hair follicles.

Types

In this article, we will discuss the main lists of cicatricial alopecia and provide a detailed explanation of each type.

  1. Central centrifugal cicatricial alopecia (CCCA) CCCA is a type of cicatricial alopecia that primarily affects women of African descent. It is characterized by the progressive loss of hair from the crown of the scalp, with the hairline remaining intact. The hair loss is due to the scarring of the hair follicles, which leads to permanent hair loss. The exact cause of CCCA is unknown, but it is believed to be related to tight hairstyles such as braiding and cornrows.
  2. Folliculitis decalvans Folliculitis decalvans is a type of cicatricial alopecia that results from inflammation of the hair follicles. This inflammation leads to scarring of the hair follicles, resulting in permanent hair loss. The condition is more common in men than in women and is typically seen in young adults.
  3. Lichen planopilaris Lichen planopilaris is a type of cicatricial alopecia that is characterized by itching and the development of small red bumps on the scalp. The hair loss is due to the scarring of the hair follicles, which leads to permanent hair loss. The condition is more common in women than in men and is typically seen in young adults.
  4. Frontal fibrosing alopecia is a type of cicatricial alopecia that is characterized by hair loss along the frontal hairline. The hair loss is due to the scarring of the hair follicles, which leads to permanent hair loss. The condition is more common in women than in men and is typically seen in postmenopausal women.
  5. Scarring alopecia due to discoid lupus erythematosus is an autoimmune disease that can cause hair loss due to scarring of the hair follicles. Hair loss is typically seen on the scalp, but can also occur on other parts of the body. The condition is more common in women than in men and is typically seen in young adults.
  6. Tufted folliculitis is a type of cicatricial alopecia that is characterized by the formation of tufts of hair on the scalp. The hair loss is due to the scarring of the hair follicles, which leads to permanent hair loss. The condition is more common in men than in women and is typically seen in young adults.
  7. Scarring alopecia due to the pseudopelade of Brocq Pseudopelade of Brocq is a type of cicatricial alopecia that is characterized by patches of hair loss on the scalp. The hair loss is due to the scarring of the hair follicles, which leads to permanent hair loss. The condition is more common in women than in men and is typically seen in middle-aged individuals.

Causes

There are several causes of cicatricial alopecia, including autoimmune diseases, infections, and physical damage to the hair follicles.

  1. Autoimmune Diseases
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Autoimmune diseases, such as lupus and scleroderma, can cause cicatricial alopecia. These diseases cause the immune system to attack healthy hair follicles, causing inflammation and scarring. The scarring can cause permanent hair loss and prevent new hair growth.

  1. Infections

Infections, such as fungal infections and bacterial infections, can cause cicatricial alopecia. These infections can cause inflammation and damage to the hair follicles, leading to scarring and permanent hair loss. Fungal infections, such as tinea capitis, are common in children and can cause patchy hair loss. Bacterial infections, such as folliculitis, can cause inflammation and scarring of the hair follicles.

  1. Physical Damage

Physical damage to the hair follicles, such as from tight braids, hot combs, and chemical relaxers, can cause cicatricial alopecia. This type of damage can cause inflammation and scarring of the hair follicles, leading to permanent hair loss. Physical damage can also cause traction alopecia, which is a type of cicatricial alopecia caused by pulling on the hair, such as from tight braids or extensions.

  1. Radiation Therapy

Radiation therapy, used to treat cancer and other medical conditions, can cause cicatricial alopecia. Radiation therapy can damage the hair follicles and cause scarring, leading to permanent hair loss. This type of hair loss is more common in people who receive radiation therapy to the head or neck.

  1. Genetic Predisposition

Some people may have a genetic predisposition to cicatricial alopecia. This means that they are more likely to develop this type of hair loss due to a genetic predisposition. This type of hair loss is more common in people with a family history of autoimmune diseases, such as lupus or scleroderma.

  1. Idiopathic Scarring Alopecia

Idiopathic scarring alopecia is a type of cicatricial alopecia that occurs without a known cause. This type of hair loss can cause patchy hair loss, and the hair follicles may be replaced by scar tissue. This type of hair loss is difficult to treat and may lead to permanent hair loss.

  1. Chemical Burn

Chemical burns can cause cicatricial alopecia. Chemical burns can cause inflammation and scarring of the hair follicles, leading to permanent hair loss. This type of hair loss can occur from exposure to harsh chemicals, such as those found in hair dyes, relaxers, and other hair treatments.

  1. Trauma

Trauma to the scalp, such as from a burn or injury, can cause cicatricial alopecia. This type of hair loss can occur when the hair follicles are damaged, causing inflammation and scarring. The scarring can prevent new hair growth and lead to permanent hair loss.

  1. Chronic Inflammation

Chronic inflammation, such as from conditions such as lic

Symptoms

There are several types of cicatricial alopecia, including lichen planopilaris, frontal fibrosing alopecia, and central centrifugal alopecia. Each type of cicatricial alopecia has its own unique set of symptoms and progression, but some of the most common symptoms include:

  1. Bald Patches: One of the first signs of cicatricial alopecia is the development of bald patches on the scalp. These patches can be small or large, and they may grow in size over time.
  2. Scalp Itching: Cicatricial alopecia can cause itching and burning on the scalp, which may be accompanied by redness and swelling.
  3. Scalp Pain: Some people with cicatricial alopecia may experience pain or tenderness on the scalp, which can be made worse by hair brushing or combing.
  4. Scalp Scarring: Cicatricial alopecia is characterized by scarring of the hair follicles, which can result in a shiny, smooth appearance on the scalp.
  5. Broken Hair: People with cicatricial alopecia may notice that their hair is breaking or snapping off at the roots. This can lead to further hair loss and a reduction in the overall thickness and volume of the hair.
  6. Hair Shaft Abnormalities: Cicatricial alopecia can cause changes to the structure of the hair shaft, resulting in hair that is brittle, dull, or easily damaged.
  7. Changes in Hair Color: In some cases, cicatricial alopecia may cause changes to the color of the hair, such as graying or loss of pigmentation.
  8. Eyebrow Loss: Cicatricial alopecia can also affect the hair in other areas of the body, including the eyebrows and beard.
  9. Nail Changes: Some people with cicatricial alopecia may also experience changes to their nails, such as ridges, pitting, or thickening.
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It is important to note that cicatricial alopecia can have a slow progression, and some people may not experience symptoms for several years. In other cases, the hair loss can be sudden and rapid, leading to complete baldness in a short period of time.

Diagnosis

Diagnosis of cicatricial alopecia involves a combination of physical examination, medical history, and various tests. The following is a list of the main diagnosis and tests used to diagnose cicatricial alopecia.

  1. Physical examination: The first step in diagnosing cicatricial alopecia is a physical examination of the scalp. The doctor will examine the scalp for any signs of hair loss, scarring, or other symptoms. This examination will help the doctor determine the type of cicatricial alopecia that the patient is suffering from.
  2. Medical history: The doctor will also ask the patient about their medical history, including any previous illnesses, medications, and treatments. This information will help the doctor determine the cause of the hair loss and the best course of treatment.
  3. Scalp biopsy: A scalp biopsy is a procedure where a small sample of skin and hair is removed from the scalp and examined under a microscope. This test helps determine the type of cicatricial alopecia and the extent of the damage to the hair follicles.
  4. Trichoscopy: Trichoscopy is a diagnostic tool that uses a specialized microscope to examine the hair and scalp. The doctor will examine the hair and scalp for any signs of hair loss, scarring, or other symptoms.
  5. Blood tests: Blood tests can be used to check for underlying medical conditions that may be contributing to the hair loss, such as autoimmune diseases, infections, or hormonal imbalances.
  6. Skin culture: A skin culture test involves taking a sample of skin from the scalp and growing it in a laboratory to see if any bacteria or fungi are present. This test can help determine if an infection is causing the hair loss.
  7. Imaging tests: Imaging tests, such as MRI or CT scans, can be used to look at the scalp and hair follicles in detail. These tests can help the doctor determine the extent of the damage to the hair follicles and plan the best course of treatment.

Once the diagnosis is made, the doctor will use the results of these tests to determine the best course of treatment. Treatment options for cicatricial alopecia include medications, hair transplantation, scalp reconstruction, and wigs or hairpieces. The type of treatment recommended will depend on the type of cicatricial alopecia and the extent of the hair loss.

Treatment

There is no cure for cicatricial alopecia, but there are several treatment options that can slow the progression of the condition and improve the appearance of affected areas. The main treatments for cicatricial alopecia include:

  1. Topical corticosteroids: Topical corticosteroids are often used to treat mild to moderate cases of cicatricial alopecia. These medications are applied directly to the scalp and can help to reduce inflammation and itching.
  2. Systemic corticosteroids: In more severe cases of cicatricial alopecia, systemic corticosteroids may be prescribed. These medications are taken orally and can help to reduce inflammation throughout the body.
  3. Immunosuppressive drugs: Immunosuppressive drugs, such as cyclosporine and methotrexate, can be used to treat cicatricial alopecia. These drugs suppress the immune system, which can help to reduce the inflammation that is causing hair loss.
  4. Antimalarial drugs: Antimalarial drugs, such as hydroxychloroquine, can be used to treat cicatricial alopecia. These drugs are thought to help reduce inflammation and improve hair growth.
  5. Topical minoxidil: Topical minoxidil is a medication that is applied directly to the scalp. It is thought to increase blood flow to the hair follicles, which can improve hair growth.
  6. Platelet-rich plasma (PRP) therapy: PRP therapy involves injecting a concentrated solution of platelets into the scalp. This solution contains growth factors that can help to stimulate hair growth and improve the appearance of affected areas.
  7. Hair transplantation: In some cases, hair transplantation may be an option for treating cicatricial alopecia. This procedure involves transplanting hair follicles from one area of the scalp to another.
  8. Wigs and hairpieces: Wigs and hairpieces can be used to cover areas of hair loss and improve the appearance of affected areas.
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In addition to these treatments, there are several things that you can do to help manage cicatricial alopecia, including:

  1. Protecting your scalp from the sun: Exposure to the sun can cause further damage to the hair follicles, so it is important to protect your scalp from the sun.
  2. Avoiding harsh hairstyles: Harsh hairstyles, such as tight braids or cornrows, can put a lot of tension on the hair follicles and can lead to further hair loss.
  3. Using gentle hair care products: It is important to use gentle hair care products, such as shampoos and conditioners that are free from harsh chemicals.
  4. Maintaining a healthy diet: Eating a healthy diet that is rich in vitamins and minerals can help to promote hair growth and improve the overall health of your hair.

It is important to see a dermatologist if you are experiencing hair loss or have a diagnosis of cicatricial alopecia. Your doctor can help you determine the best course of treatment

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References