Scarring Alopecia

What is Scarring Alopecia and What Can Be Done For It?

Scroll to see different causes
of Scarring Alopecia


Scarring Alopecia

What is Scarring Alopecia and What Can Be Done For It?

Scroll to see different causes
of Male Pattern Hair Loss



We may be familiar with ‘androgenetic alopecia’ that causes male pattern hair loss, and is mainly caused by genetic factors increasing the chances of hormonal action towards hair loss. What about ‘scarring alopecia’? 

Scarring alopecia, or ‘cicatricial alopecia’, is actually not a single condition – it is a group of disorders that result in hair follicles becoming destroyed and are replaced by scar tissue. ‘Primary’ scarring alopecia happens from the body’s own inflammatory and autoimmune process that begins to attack hair follicles to replace them with scar tissue. ‘Secondary’ scarring alopecia comes from non-follicle-directed processes or external factors causing the hair follicles to become scarred like severe infections, burns, radiation, or tumors.

The types of cicatricial alopecia are:

  • Primary – Central Centrifugal Cicatricial Alopecia (CCCA)

Central Centrifugal Cicatricial Alopecia (CCCA) is the most common form of scarring hair loss seen in middle-aged African women, although men and people of other races may also get it. The exact cause of CCCA is unknown. There may be a few components such as genetics, fungal/bacterial infections, and autoimmune disease. Hair loss typically begins at the mid-scalp and extends outwards, giving the scalp a shiny appearance when hair follicles scar. Some people may not have symptoms, and some may have tenderness, itching, and burning.

  • Primary – Frontal Fibrosing Alopecia (FFA)

Frontal fibrosing alopecia usually presents as a uniform linear band of hair loss along the front and sides of the scalp, resulting in a receding frontal hairline. When this happens, the skin over the affected area looks pale and shiny as compared to the normal facial skin that may be tanned from sun exposure. When it is in a flare, redness and scaling may be visible around the affected hair follicles, as well as facial rashes around the forehead/temples. Itching and pain are common early symptoms, occurring early before any obvious loss of hair. 

  • Primary – Lichen Planopilaris (LP)

Lichen planopilaris is a rare inflammatory condition that results in patchy and progressive hair loss on the scalp regions. Frontal fibrosing alopecia is considered a form of lichen planopilaris, but the area affected is usually different. A lichen planus infection affecting the skin is commonly associated with this condition, although the exact cause of lichen planopilaris on the follicles is unknown. The typical signs are smooth and white patches of scalp hair loss, with some scaling and redness surrounding each hair follicle at the edges of these patches. Hairs can be easily pulled out. The small areas of patchy hair loss can combine to form a larger and irregular patch.

  • Secondary – Traumatic and Cosmetic Scarring Alopecia

The external damage to your hair follicles can be caused by a number of factors. Traumas such as a car accident or a bad fall that damage the scalp may also replace hair follicles with scar tissue. Burns from cosmetic processes such as hair straighteners or chemical treatments can either take the form of an immediate bald patch, or cumulative hair loss from repeated prolonged damage. In the treatment of brain tumours, radiotherapy exposure to the scalp can also permanently destroy the hair follicles that come into direct contact with it.

Some factors that do contribute to the increased occurrence of scarring alopecia are:

  • Increased prevalence in certain demographic groups

African American women have a higher prevalence of central hair loss and development of scarring alopecia, or CCCA. This may be attributed to hair styles causing excessive traction, as well as the use of heat or chemicals in certain relaxant hair styles that may increase scalp inflammation. There also appears to be a correlation between the presence of diabetes mellitus type 2 and occurrence of CCCA, which supports the recent theory that scarring alopecia is caused by metabolic dysregulation in the body. 

  • Chemical contributions

The incidence of frontal fibrosing alopecia appears to be increasing with time, leading to suspicion of a possible environmental trigger. Some studies have found that there could be a correlation between facial sunscreen use and FFA as frequent users of sunscreen after the 90s campaign of sunscreen advocacy saw a large rise in cases. However, insufficient evidence is present to prove any causal relationship. The possibility of an association between FFA and sunscreen should be discussed with patients along with counselling on alternative sun protection measures if desired.

  • Inflammatory factors/Autoimmune conditions

Cicatricial (scarring) alopecia results from irreversible damage to epithelial stem cells located in the bulge region of the hair follicle, generally as a result of inflammatory mechanisms (eg, in the context of autoimmune disease). In primary cicactricial alopecia (PCA), the hair follicle itself is the key target of autoaggressive immunity. This group of permanent hair loss disorders can be classified into distinct subgroups, characterized by the predominant peri-follicular inflammatory cell type. In none of these PCA forms do we know exactly why hair follicles begin to attract such an infiltrate. Thus, it is not surprising that halting or even reversing this inflammation in PCA is often extremely difficult.

Scarring alopecia or cicatricial alopecia can be complex to treat as an individual’s inflammatory and autoimmune response is what drives this condition in primary cicatricial alopecia. The main goal of treatment is to stop progression of disease and prevent further hair loss. Hence, treatments should begin by stabilising the levels of inflammation in the body.

  • Medical treatment

Active inflammation of hair follicles can typically be treated by oral, topical, or injectable anti-inflammatory medications. If nodules (swollen bumps that may contain pus) exist on the scalp they may also need to be treated and drained to encourage healing. Medical treatments such as immunomodulators, hair growth boosters, and oral finasteride may be used to slow down the spread of the hair loss.

  • Addressing factors contributing to inflammation

Prolonged chronic stress and mood disorders such as anxiety can lead to high levels of inflammation markers in the body that can contribute to the occurrence of an autoimmune condition, or inflammatory flare. A psychiatrist or licensed health professional working in tandem with a specialist doctor may help in addressing such mental health conditions and subsequently improve symptoms. 

  • Hair transplant surgery

Hair transplant can only be considered in some cases where the scarring alopecia is deemed stable for many years (more than a year), since cicatricial alopecia may reactivate after a quiet period (dormant period) and treatment may have to be repeated.

The course of cicatricial alopecia is usually prolonged. Treatment is continued until the symptoms and signs of scalp inflammation are decreased, and progression of the condition has been controlled. Unfortunately, the progression of the hair loss may continue silently even when the active symptoms (e.g. itching, burning, pain, scalp tenderness/redness, scaliness, pustules) have been addressed. 

At Terra Medical, hair transplants may not be suitable for all clients, especially when it involves scarring alopecia. The good news is, our expert hair loss specialists are able to thoroughly assess your condition to identify any other possible treatments that may help to address the symptoms and prevent progression of the disease. If you would like to know more, please contact us to book a consultation today!


At Terra Medical

Hair transplantation is considered the only permanent solution to hair loss, with an average 90% success rate. Not just reserved for the hair on your scalp, hair transplantation techniques can also be used for facial hair and to fill in scarred bald patches from traumatic injuries. 

Terra Scalpboosters aim to ‘boost’ your scalp health by injecting a specially concocted cosmeceutical formulation paired with a superior cell-membrane activation technology to stimulate your hair follicles into growing faster, stronger, and healthier. Read on more to find out what it’s all about!

“Autologous Micrograft Transfer” treatment procedure offers a lot of great benefits, which makes this therapy an effective and safe one. One such benefit is that it has minimal downtime! Unlike hair transplant surgery where you may need to set aside 5-7 days before being able to continue most of your daily activities, you will be able to walk out the door right into the next thing on your schedule after a Autologous Micrograft Transfer treatment.

There have been many reviews and studies done on the safety and efficacy of low-level laser light therapy in men and women experiencing hair loss. When the wavelengths of light penetrate the scalp, it stimulates the stem cells that help to ‘communicate’ to the hair follicles for increasing hair growth. The low-level laser also increases blood flow and production of ATP, an energy-carrying molecule found in the cells of all living things, and metabolic processes in the cell to deliver more nutrients and oxygen which stimulate faster hair growth. We call this ‘activating’ the hair follicles.

Terra Medical offers array of hair supplements that are clinically proven to improve your hair health. Do ensure to consult our medical practioner if you’re unclear of which to take for optimal improvement. 

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