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Cicatricial Alopecia

What is Cicatricial Alopecia?

This condition is a type of hair loss process that is characterized by inflammation and destruction of hair follicles such that they are replaced with scar tissue. When scarring occurs, the hair is permanently lost.

What is the cause of Cicatricial Alopecia?

Cicatricial Alopecia can result from a variety of medical conditions that effect the scalp such as lichen Planopilaris, central centrifugal cicatricial alopecia (CCCA), discoid lupus, sarcoidosis, bacterial and fungal infections, as  well as traumatic injury to the scalp from burns or radiation.

What are the symptoms?

The symptoms depend upon the disease process that is causing the cicatricial alopecia to develop. There can be scaling, redness, itching, burning, tenderness, pustules and other signs of inflammation in addition to loss of hair. Sometimes an individual can develop cicatricial alopecia without any symptoms at all except the hair loss itself.

How is it diagnosed?

A skin biopsy must specimen be taken from the scalp to identify the underlying cause for the scarring. A dermatopathologist with experience in hair loss disorders reads the slides and provides a report with the diagnosis.

What tests are needed?

A dermatologist specializing in hair loss will perform two tests:

  • Scalp biopsy
  • Blood tests are done to check for any associated medical conditions such as lupus, anemia, thyroid disease, or vitamin deficiencies.

What is the expected duration?

Untreated, this condition can progress for years and lead to permanent baldness.

How can it be prevented?

There are no known preventative options.


The first treatment goal is to stop the follicle destroying inflammatory cells so that hair loss does not progress. This treatment can include oral anti-inflammatory medications such as doxycycline or hydroxchloroquine, plus topical and injected corticosteroids can used separately or together.

Early research suggests that Platelet Rich Plasma (PRP) can help with symptomatic improvement and some hair growth when done before the scarring process is complete

When the inflammation process has healed or stopped, hair transplant surgery might be beneficial

When to contact a professional

At the first sign of loss of hair thinning or progressive balding, an appointment is recommended.


The prognosis depends upon how advanced the condition is at the time a diagnosis is made and the extent of the hair that has been lost. The earlier treatment is started, the better the outcome.

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