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Cicatricial alopecia is the name for a group of hair loss disorders that destroy the hair follicle and cause scar tissue to form. The scar tissue occurs below the surface of the skin so is not observable to the eye but the damage to the hair follicle can be permanent.
At first, hair loss may occur gradually and be attributed to other causes. Some people experience more severe symptoms of burning, itching, pain and other signs of inflammation such as pustules and scaling that can become progressively intolerable. Cicatricial alopecia primarily affects adults of any nationality but can also occur in children.
Cicatricial alopecia is diagnosed after a skin biopsy is taken and the skin and hair follicles are examined under a microscope. More than one skin biopsy may need to be taken. Evaluation of skin samples containing scar tissue may give information as to whether the hair lost can still grow back. Skin examined from areas of active inflammation can give information as to the specific type of cicatricial alopecia the person has.
There are different types of cicatricial alopecia, which are classified depending on what inflammatory cells, lymphocytes or neutrophils, are seen under the microscope. Below are some of the main forms and treatments:
• Chronic cutaneous lupus erythematosus (CCLE): is a form of lupus that only appears in the skin but systemic lupus (SLE) would still need to be checked for through lab tests. This type of cicatricial alopecia appears more often in women. Treatment includes both topical and injectable corticosteroids as well as other medications such as antimalarial pills and vitamin A derivatives.
• Lichen planopilaris: is the most common type that appears in Caucasians and in women more so than men. The symptoms experienced are severe itching, burning, pain and a whitish scale on the scalp. It is treated using some of the same medications as CCLE.
• Central centrifugal cicatricial alopecia (CCCA): is seen almost entirely in African American women and begins as thinning in the crown that spreads outwards. It is thought to be related to the use of tight braiding, weaves or occlusive oil treatments and has been called “hot comb”alopecia. Treatment focuses on avoiding traction type hairstyles and taking antibiotics, topical steroids and minoxidil for hair re-growth.
• Folliculitis decalvans: appears as multiple pustules on the scalp. The hair follicle becomes scarred and permanent hair loss results. Bacteria often grow on the scalp requiring long-term antibiotic therapy along with topical steroids.
• Dissecting cellulitis: appears similar to cystic acne but occurs on the scalp. This form of cicatricial alopecia is most common in African American men. Treatment involves injecting and draining the cysts along with taking antibiotics and topical steroids.
Any form of progressive hair loss can be emotionally and psychologically devastating. Cicatricial alopecia is particularly so because of the accompanied pain and discomfort. There are support groups and resources to find doctors who are especially knowledgeable about this form of hair loss.
C.A.R.F. is an organization started by patient named Sheila Belkin and her doctor Vera H. Price, MD, as a resource for patients suffering from cicatricial alopecia. Go to www.carfintl.org/index.html to view a movie describing other’s experiences with this disorder.
The North American Hair Research Society at www.nahrs.org is another place to find information.
sources:
http://www.nahrs.org/home/Default.aspx?tabid=63
http://www.carfintl.org/faq.html#
http://www.medscape.com/viewarticle/557669
Michele is an R.N. freelance writer with a special interest in woman’s health care and quality of care issues. Other articles by Michele are at www.helium.com/users/487540/show_articles
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