Scarring (Cicatricial) Alopecia: What It Looks Like & Treatment (2024)

What is scarring alopecia?

Scarring alopecia, also called cicatricial alopecia, is a type of hair loss caused by the destruction of your hair follicles (shafts on the surface of your skin that hair grows through). It’s usually the result of infections, chemicals, burns or autoimmune disorders. Hair loss due to scarring alopecia can be permanent because your hair can’t grow back without healthy hair follicles.

What are the effects of scarring alopecia?

Scarring alopecia can affect any part of your body that has hair, but commonly affects the scalp. Visible hair loss due to scarring alopecia can also have emotional and psychological effects.

What does scarring alopecia look like?

Scarring alopecia usually appears as a bald patch where there’s typically hair. There might be one bald area or several. The skin where hair used to be tends to look smooth and shiny. Scarring alopecia can look different on different people. Some people also have redness, flaky skin or blisters.

What’s the difference between scarring and nonscarring alopecia?

Scarring alopecia is permanent hair loss due to hair follicle destruction. In nonscarring alopecia, hair may fall out or get thinner, but your hair follicle isn’t destroyed. So nonscarring alopecia may be temporary, and your hair can sometimes grow back. Androgenetic alopecia, also called male or female pattern baldness, is the most common type of nonscarring alopecia.

Are there different types of scarring alopecia?

Cicatricial alopecia can be one of two types:

• Primary scarring alopecia is due to an inflammatory or autoimmune disorder that directly targets and destroys your hair follicles.
• Secondary scarring alopecia is a side effect of injury or damage to your skin. Hair loss might result from burns, infections, radiation or tumors.

There are many types of primary scarring alopecia. Some include:

• Central centrifugal cicatricial alopecia (CCCA): CCCA is the most common type of hair loss in Black women or people assigned female at birth (AFAB). It usually occurs around age 30. CCCA often starts as a bald patch on the crown of your scalp and then spreads outward. It may be related to chemical hair products, such as relaxers, or hot hair tools, such as combs. CCCA can also result from too much tension on hair follicles from braids, weaves or extensions. But some research suggests that CCCA might be hereditary.
• Chronic cutaneous lupus erythematosus (CCLE): CCLE describes skin problems caused by lupus erythematosus, an autoimmune disease. In addition to hair loss, some people with CCLE also have skin rashes, discoloration and sensitivity to the sun. CCLE is more common in women or adults AFAB.
• Folliculitis decalvans: Folliculitis decalvans may be the result of a bacterial infection. Some people with Staphylococcus aureus (Staph A), a staphylococcus infection, have ongoing inflammation that can affect their hair follicles.
• Lichen planopilaris: This is the most common primary scarring alopecia and mostly affects people over 50 who are AFAB. It’s a type of lichen planus that can cause skin scaling, burning, itching, ulcers, discoloration and papules (inflamed bumps).

Is scarring alopecia contagious?

Scarring alopecia isn’t contagious, so you can’t get it from person-to-person contact.

Who might be affected by scarring alopecia?

Anyone can get scarring alopecia. It tends to affect adults more than children. People of a certain sex or race may be more likely to develop certain types of scarring alopecia. For example, central centrifugal cicatricial alopecia (CCCA) is the most common type of hair loss in Black people AFAB.

How common is scarring alopecia?

Scarring alopecia accounts for about 7% of people who see healthcare providers about hair loss. So it’s much less common than nonscarring alopecia, which affects between 50% and 75% of adults over 50.