Alopecia Cicatrisata: Understanding the Causes and Treatment Options

Alopecia Cicatrisata: A Comprehensive Overview

Definition

Alopecia cicatrisata, also known as scarring alopecia, refers to a specific type of hair loss characterized by permanent destruction of hair follicles and replacement by scar tissue. Unlike non-scarring alopecia, where hair follicles remain intact and hair loss is reversible, cicatricial alopecia results in irreversible loss of hair.

Etiology

The causes of alopecia cicatrisata are diverse and include:

• Autoimmune diseases: Conditions like lichen planus, lupus erythematosus, and alopecia areata can damage hair follicles.
• Infections: Bacterial, fungal, and viral infections can lead to scarring.
• Trauma: Severe burns, lacerations, or radiation therapy can cause scarring.
• Neoplasms: Cancers of the scalp can spread to hair follicles and cause scarring.
• Congenital disorders: Certain genetic conditions, such as aplasia cutis congenita, can result in the absence of hair follicles at birth.

Types

Alopecia cicatrisata can be classified based on its etiology and clinical presentation into two main types:

Primary Alopecia Cicatrisata: This is a rare form of hair loss that affects specifically the hair follicles and is not associated with systemic diseases.

• Lichen planopilaris: A chronic inflammatory condition characterized by violaceous, scaly patches on the scalp with hair loss and scarring.
• Folliculitis decalvans: A severe form of folliculitis that results in scarring and hair loss.
• Central centrifugal cicatricial alopecia: A progressive hair loss that starts in the crown and spreads outward.

Secondary Alopecia Cicatrisata: This type of scarring alopecia is caused by underlying systemic diseases or external factors.

• Discoid lupus erythematosus: An autoimmune disease that causes red, scaly patches on the scalp with hair loss and scarring.
• Scleroderma: A connective tissue disorder that can affect the scalp, leading to hair loss and scarring.
• Traumatic alopecia: Hair loss caused by burns, lacerations, or radiation therapy.
• Neoplastic cicatricial alopecia: Hair loss due to tumors or cancers invading the scalp.

Clinical Features

The clinical presentation of alopecia cicatrisata depends on the underlying cause and severity of the condition. Common features include:

• Scarring: The primary sign is the presence of scar tissue in place of hair follicles.
• Hair loss: Hair loss can vary from small patches to complete baldness of the affected area.
• Inflammation: The scalp may show signs of inflammation, such as redness, swelling, or pain.
• Follicular plugging: Keratinized material may accumulate in the hair follicles, forming black dots.
• Atrophy: The scalp skin may become thinned and pale in areas of scarring.

Diagnosis

Diagnosis of alopecia cicatrisata involves a thorough medical history, physical examination, and appropriate investigations:

• Scalp biopsy: A small sample of scalp skin is removed and examined under a microscope to confirm the presence of scarring.
• Blood tests: To rule out underlying autoimmune or systemic diseases.
• Imaging studies: May be used to assess the extent of scarring or identify underlying neoplastic processes.

Treatment

The treatment of alopecia cicatrisata focuses on addressing the underlying cause and managing the symptoms. Treatment options may include:

• Medical therapy: Medications such as antibiotics, antifungals, or immunosuppressants can be used to treat infections and autoimmune conditions.
• Topical therapy: Steroid creams or lotions may be applied to the scalp to reduce inflammation.
• Surgery: Rarely, surgery may be an option to remove scars or restore hair growth.
• Hair transplantation: Hair follicles from unaffected areas can be transplanted to bald patches.
• Camouflage: Wigs, hairpieces, or scalp micropigmentation can help conceal hair loss.

Prognosis

The prognosis for alopecia cicatrisata varies depending on the underlying cause and the severity of scarring. In some cases, early diagnosis and treatment can help prevent further scarring and hair loss. However, in severe cases, permanent hair loss may be inevitable. Regular follow-up and monitoring are essential for managing the condition effectively.

Conclusion

Alopecia cicatrisata is a challenging condition characterized by irreversible hair loss due to scarring. The diverse causes and clinical presentations require a thorough evaluation to determine the appropriate treatment approach. Early intervention and proper management can help optimize outcomes and improve quality of life for affected individuals.