Cicatricial Alopecia An Uncommon Hair Loss Condition

By Theresa Mosely, Trichologist

Hair Colour Studio

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Cicatricial Alopecia An Uncommon Hair Loss Condition

Cicatricial alopecia (CA), also known as scarring alopecia, is an uncommon inflammatory hair loss condition which is irreversible, and neither life threatening nor painful. It is widely considered to be an auto immune disorder. Currently the most popular opinion on the classification of primary cicatricial alopecias among dermatologists is that of the North American Hair Research Society (NAHRS). The research society's opinion is based on the inflammatory cell type (lymphocytic or neutrophilic) noticed/detected in scalp biopsy specimens. These inflammatory cell types target and destroy the stem cells in the bulge area of the hair follicles.

Scarring alopecia is divided into primary and secondary conditions. The hair follicles, and follicular ostia, which is the single most visible factor that identifies scarring alopecia, are specifically targeted in primary cicatricial alopecia, while other tissues and organs are affected in secondary cicatricial alopecia. The onset and progression of cicatricial alopecia can have serious psychosocial consequences, such as causing intense emotional suffering, and personal, social and work-related problems.

The diagnosis of primary cicatricial (scarring) alopecia (PCA) can be difficult as scarring may not occur initially. According to the Journal of Cutaneous Pathology the diagnosis of PCA remains one of the most challenging fields of dermatopathology. A clinical approach, followed by examination of the scalp, and scalp biopsy are important steps toward obtaining an accurate diagnosis.

Trichoscopy, considered to be a new frontier for the diagnosis of hair and scalp disease, is a non-invasive technique used to visualize the hair shaft and helps in the evaluation of hair shaft and hair abnormalities. Changes in scalp appearance are manifested as bald patches and receding hairline. Scalp dermoscopy (trichoscopy) does not only facilitate diagnosis of hair disorders but also gives clues about disease stages and progression.

The treatment of cicatricial alopecia is considered one of the most difficult tasks for dermatologists and clinicians. This disease must be monitored through regular clinical evaluation, trichoscopy, and photos. One of the best methods of assessing response to treatment is hair counting while undergoing trichoscopy.

The aim is to slow or stop the progression of inflammation of the follicles and the scarring process at the earliest phase of involvement. The primary goal of treatment is to arrest any further hair loss.