It can be frightening to find smooth patches of skin where hair was once present. Each case of scarring alopecia can appear differently in different people, but the same upsetting process is at work. We’re taking a deep dive into this guide to scarring alopecia so we can better understand this relatively rare condition that affects some 7% of people worldwide.

What Is Scarring Alopecia?

Scarring alopecia, also known as cicatricial alopecia, is a type of hair loss that occurs when hair follicles become damaged, leading to permanent hair loss. (Often characterised by painful, itchy patches of baldness with an inflamed or scarred appearance. )While it is not always clear what causes it, it can be a result of an autoimmune disorder, inflammation, or other skin conditions.

The National Organisation of Rare Diseases tells us, “Primary cicatricial alopecia refers to a diverse group of rare disorders that destroy the hair follicle, replace it with scar tissue, and cause permanent hair loss.

“Hair loss can be gradual, without symptoms, and unnoticed for long periods. In other cases, the hair loss may be associated with severe itching, pain and burning and progress rapidly. Cicatricial alopecia occurs in otherwise healthy men and women of all ages and is seen worldwide.”

What Causes Scarring Alopecia?

The exact cause of this condition is unknown, but it is believed to be related to certain medical conditions, genetic factors, and certain medications.

WebMD tells us that common medical conditions associated with scarring alopecia include:

  • Lupus
  • Lichen planopilaris
  • Scleroderma
  • Bacterial or fungal infections

Certain medications, such as blood thinners, retinoids, and chemotherapy drugs, can also increase the risk of scarring alopecia.

Genetics may also play a role, as some people are more likely to develop the condition than others.

Genetic Factors and Scarring Alopecia

Certain genes are linked to the development of scarring alopecia, such as the IRF4 gene.

The IRF4 gene, also known as interferon regulatory factor 4, is a gene that is involved in the development of the immune system. It has been linked to certain forms of hair loss, including scarring alopecia. Mutations of the IRF4 gene can result in an increased risk of developing scarring alopecia, as well as other conditions such as lupus and lichen planopilaris. Research is ongoing to determine how this gene affects the development of hair loss.

One source notes, “IRF4 activity is regulated by STAT3, a signalling protein that responds to inflammatory signals and controls the expression of genes involved in the growth, development, and activation of immune system cells.

What Are The Symptoms of Scarring Alopecia?

Symptoms of scarring alopecia include patchy bald spots, broken hairs, and scarring on the scalp. Other symptoms may include an itchy, burning, or tender scalp and changes in the texture and colour of hair. These symptoms may appear gradually over a period of months or years or quite suddenly.

A Guide to Scarring Alopecia Treatments

A dermatologist or trichologist will typically diagnose traction alopecia. They will perform a physical examination of the scalp and may take a biopsy of the affected area to determine the cause and extent of the hair loss. You may require additional blood work to determine underlying medical conditions. Additionally, other tests may be performed to ascertain whether fungal infections are at work.

Treatment depends on the severity and type of scarring alopecia you have. It can be treated with topical steroids or immunosuppressants in mild cases, while more severe cases might require oral steroids or even surgery. In some cases, a combination of treatments may be necessary.

Is Scarring Alopecia Different to Traction Alopecia?

Scarring alopecia and traction alopecia are both hair loss disorders, but they differ in cause and treatment. Excessive and repetitive tension on the hair follicles, usually from hairstyles such as ponytails, braids, and buns, results in traction alopecia. On the other hand, scarring alopecia is caused by inflammation of the hair follicles due to medical conditions, medications, or genetics. While the treatments for the two conditions differ, they are both chronic disorders and can cause irreversible hair loss and baldness.

What Is The Prognosis?

The prognosis for people with scarring alopecia is largely dependent on the type and severity of the condition. Hair loss can be reversed, in some cases, with the proper treatment. In other cases, the hair loss is permanent. The most important thing is to visit a trichologist to get proper diagnosis and treatment options.

With the right treatment and management, it may be possible to minimise hair loss and, in some cases, regrow hair.

Are There Any Lifestyle Changes That Can Help Manage Scarring Alopecia?

Yes, there are certain lifestyle changes that can help manage scarring alopecia. These include avoiding excessive heat or styling tools such as blow dryers or flat irons and using high-quality, gentle hair care products.

It is also important to keep the scalp clean and hydrated by using products created specifically for people with scarring alopecia.

Additionally, it is important to pay attention to overall health and reduce stress levels. Eating a balanced diet, exercising regularly, and getting enough sleep can also help manage scarring alopecia. Finally, it is important to visit the right professional who can assess the condition and create a holistic treatment plan tailored to the individual.

Talk to Us

We do hope that our guide to scarring alopecia has helped you to understand this chronic hair loss disorder that can cause permanent hair loss and baldness. If you are experiencing scarring alopecia symptoms, getting a proper diagnosis and immediate treatment is important. The prognosis for people with scarring alopecia is largely dependent on the type and severity of the condition. However, with the right treatment and management, it is possible to minimise the effect of the condition for some.

If you or someone you know is suffering from this distressing condition, please get in touch with us as soon as possible. Let’s find a way forward together. 


Q: When does traction alopecia become scarring alopecia?

A: Traction alopecia is a condition that can cause hair loss, particularly around the hairline, due to excessive pulling or tension on the hair. If this condition is left untreated, it can lead to scarring alopecia, which is a more severe form of hair loss. Scarring alopecia is a condition where the hair follicles are permanently damaged, resulting in irreversible hair loss. It is important to seek treatment for traction alopecia as soon as possible, as scarring alopecia can be difficult to treat. If you are experiencing hair loss or thinning, it is important to speak to a qualified trichologist who can help diagnose the problem and provide appropriate treatment options. Don’t wait until it’s too late. (Read more in our article: Can Hair Grow Back After Scarring Alopecia (Cicatricial Alopecia)?)

Q: What is CCCA?

A: CCCA stands for central centrifugal cicatricial alopecia, a type of hair loss that primarily affects women of African descent. This condition is characterised by progressive scarring and hair loss that typically starts at the crown of the head and spreads outwards. CCCA can be a challenging and distressing condition to deal with, and it’s essential to seek professional help from a specialist who can provide a diagnosis and treatment plan. If you or someone you know is experiencing hair loss or other symptoms associated with CCCA, it’s important to remember that you’re not alone, and there is support available to help you.

Q: What is Frontal Fibrosing Alopecia?

A: Frontal Fibrosing Alopecia (FFA) is a condition that affects hair follicles, primarily in post-menopausal women. It is a form of scarring alopecia that causes hair loss along the frontal hairline and temples. The hairline can also appear to recede, and the eyebrows may thin or completely disappear. It can be a distressing experience to lose hair, and FFA can have a significant impact on a person’s self-esteem and confidence. It’s important to seek medical advice if you suspect you may have FFA. Treatment options are available that can help slow hair loss, but we encourage you to talk with a trichologist as soon as possible.

Q: What is Lichen planopilaris?

A: Lichen planopilaris is a chronic inflammatory condition that affects hair follicles and often results in hair loss. It’s a relatively rare condition, and the exact cause is not fully understood. However, it’s thought to be an autoimmune disorder in which the body’s immune system attacks hair follicles. Lichen planopilaris can be distressing and affect your self-esteem, particularly if hair loss is extensive. It’s essential to seek medical advice as soon as possible if you notice any changes in your hair or scalp. Treatment options for lichen planopilaris include topical and oral medications, as well as steroid injections, and a trichologist can help determine the best course of action for you.

Q: What is Discoid lupus erythematosus (DLE)

A: Discoid lupus erythematosus (DLE) is a chronic autoimmune disease that primarily affects the skin. It is a form of lupus that is limited to the skin and does not involve any of the internal organs. DLE is characterized by the development of round or oval lesions on the skin that are typically red, scaly, and thickened. These lesions can appear anywhere on the body but are most commonly found on the face, scalp, and ears. In some cases, DLE can lead to scarring and hair loss. The exact cause of DLE is unknown, but it is thought to be triggered by a combination of genetic and environmental factors. Treatment for DLE may include the use of topical or oral medications, as well as avoiding triggers such as sunlight.

leena solimanleena soliman
06:19 17 May 23
Came here when I had some issues and they were able to help massively! They are not like other claimed trichologist that want to scare you and take your money, they are backed up with their qualification and experience. Reasonably priced consultation, treatment and products!
zoe Innzoe Inn
17:24 15 Feb 23
From my first consultation, I knew this was the right place for my hair.Teresa and Eleanore are very caring. The treatments are also very relaxing and my hair adores their products!
19:01 01 Dec 22
Thank you so much Fulham scalp and hair clinic for restoring the health of my scalp and my hair.Straight talking, no nonsense, friendly and professional advice and if you follow it you’ll see results.They really know their stuff and I highly recommend.
Nico PopNico Pop
18:42 13 Jan 22
Booked the initial appointment as I have damaged hair due to bleaching and I had an itchy scalp on a very small region at the back of the scalp. As a healthcare professional myself I did not expect the trichologist to have a magic wand and cure me in one session. 3 appointments ( almost 3 months) in and buying all products recommended (7 of them - the calming scalp cream is missing in the picture) , my scalp became extremely flaky and itchy to an extent that It kept me awake at night. When informed the trichologist my experience, the only recommendation was to trial the Cade oil shampoo... which caused me further discomfort and irritation.I had to stop using all their products as I couldn't stand the itchiness and inflammation anymore (although used the cade oil shampoo several times). Who would've thought that going to a trichologist you will end up with and super irritated and itchy scalp?!Very disappointed with the overall experience, I felt the focus was mainly on selling their products, booking for treatments and not necessarily helping me with my concerns, especially that the professional did not have any concers re my condition, 400£ later I ended up booking an app with the Dr in order to solve the issues caused by their products.
03:56 06 Jun 19
I really hated my experience at Fulham Scalp & Hair Clinic and I would not recommend it at all. The reason why I visited was because I had concerns about changes I saw in my hair, particularly the amount of hair I was losing at the sides (edges).I booked an appointment which comprised of a consultation + 1st treatment. I had the consultation with the owners daughter who asked me about my hair routine, health, products and also took a sample of my hair to look at underneath a microscope. During the consultation the main points she explained to me were that blow drying my hair was bad, the hair needed to be washed more often and hair grease and oils were very bad for my hair despite the fact I have been using them my whole life and I had a good amount of hair. After the consultation she then washed it with their own branded hair products, steamed it did some light therapy and then braided it. She then told me that I would have to come back at some point for a trim and that her mother (the owner) was the only one that could do it. At the end she gave me some basic instructions about using the hair products, and I also purchased some of their products.A few days using their products I experienced a very high level of dryness to my scalp even though I was using A LOT of products everyday my hair would be extremely dry after a couple of hours. When I called them about it the receptionist answered and said the clinic was really busy and that I should try and use coconut oil despite not even being a qualified trichologist, and the trichologist warning that oils were bad for the hair! At my next appointment for the trim I was treated by the owner, she made remarks about how dry my hair was (even though I was following the instructions and using ONLY their products), and how as a black person I should be proud of my hair and wear more natural hair styles, and throw away the blow dryer. She washed my hair and then trimmed it! Which I had never heard of in my life especially with afro hair because it can shrivel up to virtually nothing so when you cut even what seems like the tiniest bit it is actually a lot, but she insisted that it was the "correct" way. During the trim I found it really humiliating and embarrassing because in the styling room I was sat next to another lady who was also having her hair treated and I just really hated every moment of the owner trimming my hair and also lecturing me in it's damaged state like that. Over the course of 3 months following the instructions, steaming my hair everyday, and washing it once a week and using the products my hair just got worse and also breaking, knotty,shedding, weaker, thinner, and shorter than it was originally at my first consultation. I was really upset, especially as when I contacted them about my concerns they kept saying my hair was just "adapting".I eventually discontinued their advice and products,It didn't happen overnight but my hair eventually gradually got back to how it used to be, by doing the "bad" things such as blow drying, using greases and oils and washing it less often. I feel that Fulham Scalp & Hair clinic are not very knowledgeable in a wide variety of hair types particularly Afro hair. They preach and say blow drying, greases and oils, weaves,wigs and not washing your hair often are bad for the health of your hair yet there are thousands of videos on YouTube which contradict these "theories". I feel they cater more to people with looser hair types and not coarser hair types, the products they sell are also very expensive especially as they do not even contain a lot in them mostly comprise of menthol and water. They also seem to care more about their old customers and do not even ask for feedback from new customers, are really hypocritical of your hair choices even though they wear their hair pin straight. Don't waste your money here, if you are having hair problems think closer to, lifestyle change, stress etcI wasted almost £300 here with no results, think carefully before visiting this clinic, do your own research first!!!
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