The Causes, Symptoms, and Treatments of Cicatricial Alopecia

Hair loss is a concern that affects millions of individuals globally, with various conditions causing it. One of the lesser-known yet significant forms of hair loss is Cicatricial Alopecia (CA), characterized by its unique feature of scarring. In this article, we will delve into cicatricial alopecia, exploring its causes, symptoms, and available insights into this less common but potentially severe hair loss condition.

Cicatricial Alopecia hair loss

What is Cicatricial Alopecia?

Cicatricial alopecia, also known as scarring alopecia, is a rare disorder characterized by the destruction of hair with scar tissue. Unlike most forms of hair loss, cicatricial alopecia typically results in permanent loss, as the damaged hair follicles cannot regenerate. The underlying causes of these conditions vary and may include autoimmune reactions, inflammatory, infections, or physical trauma to the scalp. Cicatricial alopecia can present in various patterns, including patchy hair loss or diffuse thinning. Accurate diagnosis by a dermatologist is crucial, as treatment depends on the specific subtype and underlying cause of the condition. Although the hair loss in cicatricial alopecia is usually irreversible, managing the underlying cause and preventing further scarring is a primary goal in the management of these conditions.

Causes of Cicatricial Alopecia

Cicatricial alopecia is caused by the destruction of hair follicles and their replacement with scar tissue. The underlying causes of these conditions can vary, and they often involve inflammatory or autoimmune processes. Here are some of the factors that can lead to cicatricial alopecia:

  • Autoimmune Reactions: In some cases, the immune system mistakenly targets and attacks hair follicles as if they were foreign invaders. This immune response can lead to inflammation and scarring of the hair follicles, ultimately resulting in hair loss.
  • Inflammatory Disorders: Certain inflammatory skin conditions, such as lichen planopilaris, frontal fibrosing alopecia, or dissecting cellulitis, can cause inflammation around hair follicles. Over time, this inflammation can lead to scarring and permanent hair loss.
  • Infections: Bacterial, fungal, or viral infections of the scalp can lead to inflammation and damage to hair follicles. The healing process can result in scar tissue formation and hair loss.
  • Physical Trauma: Trauma to the scalp, such as burns or injuries can damage hair follicles and cause CA in the affected areas.
  • Genetic Factors: Some forms of CA may have a genetic predisposition, meaning they run in families. The exact genetic factors are often not well understood.

It’s important to note that cicatricial alopecia can present in various patterns and several subtypes with different underlying causes and characteristics. Accurate diagnosis by a dermatologist is crucial for determining the specific subtype and identifying the underlying cause, as treatment approaches may vary accordingly. While the hair loss in cicatricial alopecia is typically irreversible, managing the underlying condition and preventing further scarring is a primary goal in the management of these conditions.

Symptoms of Cicatricial Alopecia

The symptoms can vary depending on the subtype and underlying cause. However, common symptoms associated with cicatricial alopecia include:

  • Hair Loss: Hair loss is the primary and most prominent symptom of CA. This hair loss can occur in various patterns, such as patchy areas of baldness, diffuse thinning, or a receding hairline. This depends on the specific subtype.
  • Scalp Inflammation: Many individuals with CA experience inflammation of the scalp. This inflammation can cause redness, itching, burning, or tenderness in the affected areas.
  • Scalp Changes: Over time, the inflammation and damage to hair follicles can lead to changes in the appearance and texture of the scalp. These changes may include scarring, scaling, or the development of raised or depressed areas on the scalp.
  • Hair Follicle Destruction: In CA, hair follicles are gradually replaced by scar tissue. This process can result in a loss of the normal structures associated with hair follicles, making regrowth impossible.
  • Hair Pull Test: In some cases, a hair pull test may be performed by a healthcare professional to assess the presence of active hair follicles. In CA, there may be a lack of hair shafts when hairs are gently pulled from affected areas.
  • Nail Abnormalities: In certain subtypes of CA, individuals may also experience changes in their fingernails or toenails, such as pitting (small dents or depressions), ridges, or other nail abnormalities.

While the hair loss in cicatricial alopecia is typically irreversible, managing the underlying condition and preventing further scarring are primary goals in its management.

Treatment Options

The treatment options for cicatricial alopecia aim to manage the underlying cause of inflammation and prevent further scarring. It’s important to note that while these treatments may help control the condition, they typically cannot reverse hair loss. This is due to damaged hair follicles are replaced by scar tissue. Here are some common approaches:

  • Corticosteroids: Topical or injectable corticosteroids can help reduce inflammation and slow the progression of scarring in some forms of CA. They are often the first-line treatment.
  • Topical Calcineurin Inhibitors: Medications like tacrolimus and pimecrolimus can be applied topically to suppress the immune response and inflammation in the affected areas. They may be considered when corticosteroids are not effective or suitable.
  • Oral Medications: In more severe cases, oral medications like oral corticosteroids, retinoids, or antimalarial drugs may be prescribed to control inflammation.
  • Antibiotics or Antifungals: In cases where infections contribute to inflammation, antibiotics or antifungal medications may be used to treat the underlying infection.
  • Biologics: Forms of CA, particularly those with a strong autoimmune component, biologic drugs that target specific immune pathways may be considered.
  • Plasma Rich Platelet (PRP): PRP involves injecting a concentrated solution of the patient’s own platelets into the scalp to stimulate hair growth and reduce inflammation.
  • Laser Therapy: Low-level laser therapy (LLLT) devices may help reduce inflammation and promote hair regrowth in some individuals.
  • Hair Transplant: In cases where the inflammation has been controlled, hair transplant surgery can be considered to restore hair. This is typically not done until the condition is stable.
  • Supportive Care: Maintaining proper scalp hygiene and using mild shampoos and conditioners can help manage the symptoms and improve overall scalp health.


Cicatricial Alopecia is a rare and often challenging form of hair loss characterized by scarring of the hair follicles. While the condition may not be fully reversible, early diagnosis and appropriate treatment can help manage symptoms and halt further progression. Consulting with a dermatologist or healthcare professional is crucial for individuals experiencing symptoms of Cicatricial Alopecia, as they can provide a tailored treatment plan to address the specific needs of each case and provide support for managing this unique and potentially distressing condition.

Want to Learn More?

View the latest scientific paper on Cicatricial Alopecia from the National Library of Medicine. 

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