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Scarring alopecia is a group of diseases in which irreversible hair loss occurs as a result of replacing the hair follicles with fibrous connective tissue and vitrified collagen. What are the causes and symptoms of scarring alopecia? How is the treatment going?

Scarring alopeciais a relatively "young disease" that was only described twenty years ago. Since then, so many cases of this type of alopecia have been reported that some consider scarring alopecia to be one of the most common reasons why patients present themselves with hair loss. Scarring alopecia is considered by some to be a rare variant of another dermatological disease such as lichen planus. Scarring alopecia most commonly occurs in postmenopausal women, however, the prevalence is increasing in both sexes of all ages.

Scarring alopecia: causes and pathogenesis

Scarring alopecia can be primary or secondary.Primary scarring alopeciais when the disease immediately attacks the hair follicles, whilesecondary scarring alopeciais where hair loss occurs as a result of other processes that roll in the dermis and consequently damage the hair follicles. Such diseases include, but are not limited to, viral, bacterial and fungal infections.

The pathogenesis of scarring alopecia has not been fully understood. However, it is believed that autoimmune factors play a key role in the disease, which is supported by the coexistence of scarring alopecia along with other related diseases. These include lupus erythematosus, scleroderma or lichen planus. The fact that it is a disease especially found in postmenopausal women suggests that hormonal factors must also play a role here, but so far it has not been possible to prove it.

The factors that can cause scarring alopecia include injuries, for example thermal and chemical burns, frostbites, radiation.

By some authors, scarring alopecia is closely associated with some developmental defects, including spina bifida, hydrocephalus andhearts.

It has been shown that there is a certain family predisposition to develop scarring alopecia, but the research to date does not indicate any mechanism or specific gene that may be associated with this disease.

  • What makes scarring alopecia a permanent and irreversible process?

The structure of the hair follicle should be remembered here. A hair follicle is a narrow "channel" through which hair arises and grows. There is a bulb at the bottom of the hair follicle where the hair begins to grow. A little higher is the narrowing which gradually widens to form a funnel. At the level of the narrowing, there is a structure called bulge, and in it there are stem cells, which, through numerous divisions and differentiation, enable the hair to regenerate in subsequent growth cycles. In other types of alopecia, inflammatory processes primarily "attack" the bulb of the hair, causing the hair to fall out. In scarring alopecia, however, the infiltration of inflammatory cells also covers the remaining structures of the follicle, including the bulge. The destruction of the stem cells that are in it causes an irreversible loss of the hair's ability to regenerate and grow. Both this and the process of fibrosis that attacks the hair follicle result in permanent hair loss.

Scarring alopecia: symptoms and course

Common symptoms reported by patients are:

  • burning and itching sensation of the scalp
  • pain felt when touching the hair (also called trichodynia)

In the early phase, there are characteristic erythematous and keratinized lesions that are localized periwallonally. In the areas where such inflammatory changes occur, hair is simultaneously lost in different stages of growth. The disease mainly affects the fronto-temporal areas, less often it is accompanied by changes behind the ears, and also in the parieto-occipital area.

In approximately 80 percent of cases, scarring alopecia also affects the eyebrows, and in less than 20 percent - the eyelashes.

It is estimated that every fourth person experiences hair loss elsewhere than the head, and it can rarely affect the entire body. Scarring alopecia is a chronic disease and its prognosis is difficult to assess. Most often, hair loss is quite slow. Less often, the disease is more aggressive, lightning-fast, and then it mainly affects many parts of the body.

Diagnosis of scarring alopecia

The physical and physical examination of the patient plays a key role in the diagnosis of scarring alopecia. During the testthe doctor should assess the appearance of the hair loss areas.

Using a dermatoscope may help. The characteristic feature of scarring alopecia is the lack of visible hair follicle outlets as a result of their overgrowth (scarring), and there may also be erythema and hyperkeratosis. The behavior of the hair follicle mouth suggests non-scarring alopecia, such as alopecia areata.

Finally, the "sentence" in the diagnosis of scarring alopecia has a histological examination. For this purpose, a skin biopsy is performed, preferably one that shows clear signs of inflammation. The examination can confirm the atrophy and scarring of the hair follicles and will reveal an inflammatory process that takes place in the deeper layers.

Scarring Alopecia: Differential Diagnosis

Scarring alopecia should be differentiated first from androgenic alopecia, which also frequently occurs in postmenopausal women as a result of hormonal changes. In androgenetic alopecia, however, a dermatoscope examination allows you to visualize the hair follicle orifices, as well as the areas of the hair follicle.

Pulling alopecia is a disease in which the hair follicles become fibrotic as a result of a mechanical injury (hair pulling) rather than an inflammatory process. We also do not see erythematous changes or hyperkeratosis per follicle. In the differential diagnosis of scarring alopecia, one should also take into account alopecia areata, which may also be associated with autoimmune processes, but is not manifested by fibrosis of the hair follicles.

Treatment of scarring alopecia

If the hair follicles are replaced by fibrous tissue, the loss of hair is irreversible and there is no chance of it growing back.

Sometimes the disease is self-limiting and hair loss is stopped, but most often it progresses gradually.

Early treatment may stop the process of baldness and "save" the hair follicles that have not yet been affected by the process of fibrosis. Unfortunately, no treatment regimens for scarring alopecia have been defined, the effectiveness of which would be 100% confirmed, but combined treatments with several preparations in various forms may give satisfactory results.

One of the methods of therapy is the use of glucocorticosteroids in the form of ointments, gels or lyotons. Sometimes, local injections with these drugs are also used when the disease process covers a small part of the skin, but this can lead to skin atrophy at the injection site.Local treatment, however, does not achieve good therapeutic results and is most often used as an adjuvant in combination with systemic treatment. The drugs used orally include:

  • glucocorticosteroids - even a short therapeutic course gives good results in anti-inflammatory treatment, but with longer use one should take into account the possibility of numerous side effects;
  • tetracyclines - these antibiotics are a recognized group of drugs in anti-inflammatory treatment, have few side effects, do not require intensive monitoring and can be safely used for up to 6 months;
  • Hydroxychloroquine - is an antimalarial drug, but it can be useful in the treatment of scarring alopecia, but you should monitor your liver function and have your eyesight checked regularly as it can be detrimental to both;
  • Mycophenolate Mofetil - is a strong immunosuppressant drug used to suppress the patient's immunity. It is highly effective, but you should be careful about any infections during therapy, and take into account side effects such as nausea, vomiting or diarrhea. Regular blood tests are also necessary;
  • 5-alpha-reductase inhibitors - these anti-androgenic drugs are not prescribed for the treatment of scarring alopecia, but are used in other types of alopecia, so some doctors, in the absence of other therapeutic options, use these preparations, sometimes achieving a visible therapeutic effect.

In some cases, a hairy skin transplant or direct hair transplant may be considered, but not all patients do so. This solution can only be considered if the disease is stable and well controlled over an extended period of time. However, it should be known that the satisfactory effects of this type of therapy have not been demonstrated.

How to deal with scarring alopecia?

Drug treatment is a procedure that should always be implemented if it is not too late. It is possible in the early stages of the disease, when it is diagnosed before it affects large areas of the skin.

Currently, almost all beauty salons offer treatments to restore lost eyebrows or eyelashes. This can come at a high cost, but for some women, regaining self-confidence is worth the price.

But what to do when hair loss is irreversible? There is no need to convince anyone that permanent hair loss, especially in women, is an unpleasant experience.Menopause is a difficult period for all of them, and if it is also accompanied by alopecia, it can cause a significant deterioration of mood.

Fortunately, there are currently many methods of masking baldness, which, at least to some extent, can help the patient (because we are talking mainly about women) to deal with this experience. There are many stores, foundations and websites where you can get real hair wigs. They are made so precisely that an unaware person will not think that they may be "artificial" hair. Patients may find it difficult to get to grips with wigs at first, but over time most people find it very happy.

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Category:

Dermatology