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Scarring Alopecias--Hair Loss Part 1 (Hair Care)
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Scarring Alopecias--Hair Loss Part 1

John Kraft and Charles Lynde, MD, FRCPC

In this first of a two part series on hair loss, we will cover scarring alopecia. Alopecia is the medical name for hair loss, and is classified into scarring, and non-scarring varieties. This article will cover the scarring variety. Scarring alopecia is the condition where by hair growth is permanently impaired due to permanent injury to the stem cell of the hair follicle. The hair follicle becomes replaced by scarring fibrous tissue. Scarring alopecia can be diagnosed by a dermatologist through careful examination of the scalp, blood tests, bacterial culture and fungal tests, or a scalp biopsy. 

Primary Causes:

Folliculitis decalvans:

This condition refers to hair loss due to recurring patchy and painful follliculitis. The loss of hair is thought to be a result of the constant presence of crusting pustules which leave an area devoid of hair. Tufting of hair is also frequently seen in this condition. Treatment for this condition is considered difficult.  Topical treatments such as fusidic acid, and the long-term use of oral antibiotics are often used to treat folliculitis decalvans.

Folliculitis kelodalis:

Also known as acne keloidalis nuchae or AKN, this condition refers to chronic pustular or popular eruption that is specific to the scalp or the neck area resulting in keloid scars. This condition is most common in men of a darker skin color, but some cases have involved women and Caucasians. Early lesions are often found on the lower scalp, and cause reddening of the skin. Close shaving, constant rubbing, and otherwise picking the skin, is thought to aggravate the skin and cause AKN, and should be avoided. Optimal treatment depends on the severity of the condition, and can vary from the use of topical antiseptics and antibiotics, and corticosteroids to surgical excision of the affected area.

Lichen Planopilaris:

This condition, also known as acuminatus, is a symptom of lichen planus which causes hair loss. Lesions become red around the hair follicles, and scar, later becoming devoid of hair as it progresses. If inflammation is controlled during its early stages, the follicles can be left intact, and hair may later grow. Treatment involves topical, intralesional, and oral corticosteroids, and anti-malarials, and antibiotics. The duration of the condition varies with the median at 18 months. The cause of Lichen Planopilaris is unknown, and is more common in women.

Lupus erythematosus:

Both systemic and discoid lupus can involve the scalp, and is a form of primary scarring alopecia. Lesions start as red and scaly plateau like bumps, and may later evolve into scars without hair. Active lesions are treated with topical and intralesional corticosteroids. For more information on lupus, visit

Secondary Causes

Physical Causes:

Trauma due to physical scalp injuries can cause scarring alopecia. Burns, if severe enough can also destroy hair follicles.

Abnormal Cell Growth:

Abnormal cell growth, or neoplasms such as basal cell carcinoma, squamous cell carcinomas, lymphomas, metastatic tumours can all destroy the hair follicles, causing secondary scarring hair loss.


Bacterial or fungal infections can cause damage to, and destroy hair follicles, causing scarring alopecia. Common causes of scarring alopecia include cellulitis infection of the scalp, as well as Tinea capitis, a common fungal infection of the scalp. Treatment in the case of tinea capitis, aims to remove the fungus, which is causing the hair loss, and requires systemic antifungal therapy. For more information on fungal infections, visit

Scarring alopecias can be caused by a variety of conditions. Whatever the cause, it is important to recognize hair loss as soon as possible, and seek proper diagnosis and treatment by a doctor.


alopecia,   hair care,   scars,