Hair Restoration Blog

They have setup specific guidelines for identifying these physical traits as well as for performing hair transplantation and surgical excision in order to achieve optimal cosmetic outcomes and minimize postoperative complications.

Q:

Hi, My name is XX XX and I am from India. My age is 27 years. I am suffering from scarring alopecia from last 10 years. Initially I have 4-5 very small patches, but now they have increased slowly, these patches are very smooth and of red color. I never feel and pain, burn or sever itching on my scalp, but many times I feel sensation under my scalp area and on my face, it is just like something is moving. I have taken lots of treatments Dermatology, homeopathy, ayurveda but none of these worked, may be because I did not continue any one of them more than six month. One or two year back it was kind of arrest but from last one year it again starting and I can see some new small small smooth and red color patches. I am very depressed and don’t know what to do. Please tell me if you can help me in any kind of diagnose or treatment in your research center or by any other way, please help me out. I will be very grateful!!

A:

Scarring alopecia (Cicatricial Alopecia or CC) is a broad term that applied to a diverse group of hair loss disorders.  An inflammatory condition is usually present that causes destruction of the hair follicles.  Biopsy of the scalp is generally needed to establish the diagnosis. Treatment options are different based on the exact microscopic diagnosis.  In many cases the treatment of cicatricial alopecia is difficult and a complete recovery may not be achievable with medical treatments.

Hair transplant has been tried for the treatment of cicatricial alopecia for those who have a healthy donor hair with limited success.  In some cases the process of the disease may flare up and stimulate losing patient’s original hair along with the transplanted ones. I usually obtain a scalp biopsy from patients who have atypical patterns of baldness to role our cicatricial alopecia before planning for a hair restoration surgery in our Los Angeles Hair Restoration Centers.

My recommendation to you is to find a good dermatologist and stick with his or her plan. You need to understand that the treatment of cicatricial alopecia might be long and a complete recovery might not be achievable in many patients.

Central centrifugal cicatricial alopecia or CCCA is one of the less common causes of hair loss. This medical condition, which characterizes with circular balding, mainly on the top (vertex and crown) which can be expanding and only leave a rim or hair around the scalp with total baldness in the more central areas in extreme cases (see picture).

The causes of this type of balding are now quite known. This disease used to be called with different names such as hot comb alopecia, follicular degeneration syndrome, pseudopelade in African Americans and central elliptical pseudopelade in Caucasians. Microscopic evaluation of the hair loss areas shows evidences of inflammation in the area of disease activity, chronic and rapidly progressive skin changes with eventual complete baldness in some part of the scalp with its unique pattern.

This hair loss condition could be started with the evidences of skin inflammation (redness and itching), but this phase might be temporary and patient may not have any signs or symptoms other than hair loss with its specific pattern.

Treatment of this condition could be challenging. Treatment with medications is generally not successful in prevention of the hair loss and to reverse the process. Hair transplant could be an option, but it could not be done in the acute phase of the disease. Hair transplant for Central centrifugal cicatricial alopecia might be considered when the active phase is over and when the inflammation is completely subsided. I would like to do a small test hair transplant before committing to the actual hair transplant surgery to be assured of the survival of the hair grafts.

Cicatricial alopecia refers to a group of rare skin diseases in which hair follicle get destroyed and replaced by scar tissue. It is one of the rare causes of hair loss. Hair loss could be gradual or sudden. Hair loss could be without any symptoms or it could present with sever itching, burning and pain. There is usually no visible scar, because the inflammation is below the level of skin. Cicatricial alopecia could occur in otherwise healthy men and women of all ages.

Cicatricial alopecias could be primary or secondary. This discussion is confined to the primary cicatricial alopecias in which the hair follicle is the target of the destructive inflammatory process. In secondary cicatricial alopecias, a non-follicle-directed process or external injury, such as severe infections, burns, radiation, or tumors could cause destruction of the hair follicle.

The causes of the cicatricial alopecias are not completely known. However, all cicatricial alopecias involve inflammation directed at the hair follicle, the upper part of the follicle where the stem cells and sebaceous gland are located are generally involved. Permanent hair loss occurs when the stem cells and the sebaceous glands are destroyed. This type of hair loss is usually irreversible.

Cicatricial alopecias can affect both men and women. The majority of patients with cicatricial alopecia have no family history of a similar condition. Central centrifugal cicatricial alopecia is a type of cicatricial alopecia that is more prevalent among black woman. Frontal fibrosing alopecia on the other hand is seen most commonly in post-menopausal women.

could be seen in association with chronic skin conditions such as lupus erythematosus and in people with personal or family history of autoimmune disorder. A scalp biopsy is necessary for diagnosis of cicatricial alopecia. Presence of inflammatory cells and scarring could be diagnostic and essential for determining the type of treatment.

Treatment of the lymphocytic group of cicatricial alopecias involves use of anti-inflammatory medications such as steroids, cyclosporine, hydroxychloroquine. When hair follicle destroyed, hair will not grow back. However in some cases using minoxidil solution can help to stimulate growth of some of the remaining hair. Hair transplant could only be used in the patients who have normal healthy hair in donor area. If hair multiplication becomes a reality in the future that might potentially be an option for patients who lost their scalp hair extensively as result of this condition.