Scarring Alopecia: 

In scaring alopecia scar tissue replaces the hair follicle resulting in permanent destruction of the follicle.

Working Classification of Primary Cicatricial Alopecias (1) 

• Primary cicatricial alopecias are classified based on the immune cell type attacking the hair follicle under microscopic examination. The hair follicle is the primary target of the inflammation and destruction.

  • Vs. secondary scarring alopecia: Irreversible destruction of the hair follicle caused by trauma, burn, radiation, cancer, or infection. The hair follicle is secondarily destroyed by another process affecting the hair

Lymphocytic: Central centrifugal cicatricial alopecia, Lichen planopilaris, Frontal fibrosing alopecia, Chronic cutaneous lupus erythematosus, Graham Little syndrome, Classic pseudopelade (Brocq), Keratosis follicularis spinulosa decalvans

Neutrophilic: Folliculitis decalvans, Dissecting cellulitis/folliculitis (perifolliculitis abscedens et suffodiens), Tufted folliculitis

Mixed: Folliculitis (acne) keloidalis, Erosive pustular dermatosis, Nonspecific (end-stage)

Common causes of scarring hair loss discussed on this website include:

• Central Centrifugal Cicatricial Alopecia (CCCA)

• Discoid Lupus (chronic cutaneous lupus) Erythematosus (DLE)

• Dissecting Cellulitis of the Scalp

• Folliculitis (acne) keloidalis

• Frontal Fibrosing Alopecia (FFA)

• Lichen Planopilaris (LPP)

• Traction Alopecia (Not in the working classification but prolong traction hairstyles can lead to scarring alopecia)

References