Often, the early stages of a scarring alopecia will have inflammatory cells
around the hair follicles, which, many researchers believe, induces the
destruction of the hair follicles and development of scar tissue. However,
there is some argument about this among dermatologists, as sometimes a biopsy
from a scarring alopecia-affected individual shows very little
Scarring alopecia almost always burns out. The bald patches stop expanding
and any inflammation, itching, burning, or pain goes away. In this end stage,
another skin biopsy usually shows no inflammation around hair follicles. Bald
areas usually have no more hair follicles. Sometimes, though, hair follicles,
at least those at the periphery of a bald patch, are not completely destroyed
and they can regrow, but often all that is left are just a few longitudinal
scars deep in the skin to show where the hair follicles once were.
Scarring alopecia can involve a lot of damage and permanent hair loss. For
this reason treatment of scarring alopecia should be quite aggressive. The
nature of treatment varies depending on the particular diagnosis. Scarring
alopecias that involve mostly lymphocyte inflammation of hair follicles, such
as lichen planopilaris and pseudopelade, are generally treated with
corticosteroids in topical creams and by injection into the affected skin. In
addition, antimalarial and isotretinoin drugs may be used.
For scarring alopecias with inflammation of mostly neutrophils or a mixture
of cells, the typical treatment involves antibiotics and isotretinoin. More
experimentally, drugs like methotrexate, tacrolimus, cyclosporin, and even
thalidomide have been used to treat some forms.
Once a scarring alopecia has reached the burnt-out stage and there has been
no more hair loss for a few years, bald areas can be either surgically removed
if they are not too big or the bald patches can be transplanted with hair
follicles taken from unaffected areas.
Published on March 1, 2010