Can hair grow back after scarring alopecia?
In some cases, yes, but as with most medical conditions, there is no simple answer.
If you’re reading this article, you’ll likely have received a diagnosis from a medical professional or a qualified trichologist specialising in problems related to the scalp, skin, and hair on the body. Now, you want to know what’s to come and whether your hair can grow back after scarring alopecia (cicatricial alopecia).
It’s worth noting that the right diagnosis is absolutely essential so that the most effective protocols can be followed for the best possible outcome. Therefore, second opinions in the case of any kind of alopecia are recommended.
Introducing Scarring Alopecia
Scarring alopecia: Cicatricial (sik-uh-tree-shee-ul) from the noun cicatrice, meaning scar of healed wound, and alopecia (a-luh-pee-shee-uh) meaning baldness.
It is indeed a mouthful to say, but it refers to the really scary reality for people who once had a full head of hair and are now losing some or all of it. Alopecia per sé also includes hair loss from anywhere on the body, including some varieties that see the loss of eyelashes and brows. So, it can be a rather terrifying condition to deal with.
Healthy hair is an indicator of a healthy body and the opposite also holds true. A stressful or unhealthy lifestyle results in dull, lifeless hair. Moreover, undue or prolonged stress alone can result in male or female baldness and other types of alopecia, which, in turn, cause added distress for sufferers.
Possibly the most surprising truth about scarring alopecia is that it also, and indeed more frequently, occurs in healthy people and across all ages and nationalities. The condition presents individually too, so there is no one-size-fits-all when it comes to how it is going to look or feel.
For some, the condition is rapidly progressive along with itching, pain or a burning sensation accompanied by shedding of hair. For others, it is almost unnoticeable. Hair loss is gradual and only small patches appear. Alopecia in these latter cases may exist without detection for a few years.
Scarring alopecia is not contagious and although it does appear on occasion in adolescent males, it is seldom evidenced in children.
Five Types of Alopecia
There are a few basic types of alopecia among the almost 50 various kinds namely;
- Androgenic alopecia – receding hair on the crown or front hairline, or both. Universally, this is the number one cause of hair loss in men and women. There is no cure but treatment slows it considerably.
- Alopecia areata – small, patchy spots of balding anywhere on the head or body. No cure here again although, with treatment, lost hair can grow back. There are varying degrees of this form of balding, each with its own designated names such as alopecia totalis, universalis, and barbae (beard).
- Postpartum alopecia – noticeable hair loss 2-3 months after giving birth. Due to the cause simply being hormonal, it all returns back to normal in time.
- Traction alopecia – Hair loss at the temples, usually caused by pulling hair too tight for too long. Sometimes referred to as the ‘ballet dancer’s hairline’ because dancers often wear their hair in tight buns for long periods of time.
- Cicatricial alopecia – hair loss with scarring under the skin and we’ll unpack this variety, list its subtypes and compare it with non-scarring alopecia more fully below.
Scarring Versus Non-Scarring
Focussing now only on scarring alopecia, we need to note that this disorder causes damage to the scalp or skin due to the destruction of the hair follicles.
Though starting in the epidermal (outer) layer of skin, hair follicles extend deeper, into the dermis and even into the subcutis. With regard to scarring alopecia, the hair follicles are usually badly affected and can lead to permanent hair loss.
Primary scarring alopecia has approximately seven etiologies or causes, which fall into three categories:
- Lymphocytic – lichen planopilaris ( LLP), discoid lupus erythematosus, (CCCA) central centrifugal cicatricial alopecia (CCCA), and, pseudopelade of Brocq.
- Neutriphilic – folliculitis decalvans, dissecting folliculitis.
- Multiple causes – acne keloidalis
Secondary scarring alopecia describes cases where follicle damage is due to inflammation or destruction originating in the skin itself, or from trauma, cancer, radiation, or burns.
Hereditary / developmental scarring alopecia presents with one or multiple causes, starting with genetics but exacerbated by hormone imbalances or the natural ageing process.
What Causes Scarring Alopecia?
Here again, there are a collection of causes, which may or may not be predisposed by genetic inheritance. (The truth is that much is still being learned about the causes of this ailment.)
Some types are caused by an autoimmune disease that attacks the stem cells of the hair follicle, replacing it with scar tissue.
Year upon year of relaxing hair treatments has led some to suffer from this form of alopecia. The chemicals in the relaxants over time may have damaged the hair follicles. If your hair loss is worsening and bald patches are becoming exposed, you might be looking at a case of scarring alopecia.
There are a variety of processes to blame for destroying hair follicle stem cells and sebaceous glands (oil glands). In folliculitis decalvans, a variant of scarring alopecia, we have none other to blame than the common Staphylococcus aureus bacterial infection.
Are There Treatments for Scarring Alopecia?
Both surgical and non-surgical treatments have proven effective. Treatments need to be recommended by qualified trichologists or medical doctors specialising in alopecia. The earlier the diagnosis, the more reversible the condition – that’s the golden rule.
Rather visit a specialist hair clinic and have your concerns assessed.
It is possible to reverse scarring alopecias in some cases. In others, it has been known to stop spontaneously. This may take anywhere from one year to a decade or more though. Highly respected Dr Larry Gershowitz has a win-win approach saying;
‘Keep what you have, restore what you can, and replace what you’ve lost.’
Whether you need your eyebrow hair restored, patches on your head, beard, body, or scalp, hair clinics are well equipped to help you. Some treatments are really simple and can be accomplished over time during your lunch hour. Others may require long-term intervention alongside a qualified team of trichologists.
Is Scarring Alopecia Regrowth Possible?
In some cases, yes, scarring alopecia regrowth is possible. Recent research published in Frontiers in Medicine highlights promising advancements in the treatment of this form of alopecia. The study reveals that various therapeutic options, including platelet-rich plasma therapy, have demonstrated positive outcomes in stimulating the regrowth of hair in some individuals with scarring alopecia. While there is still much research to be done, the article confirms that there have been some positive outcomes with PRP therapy which are worth building on.
FAQ: Do Hair Transplants Work?
Understanding that most types of scarring alopecia reference the destruction of the hair follicle, surgeons need to graft hairs that are still contained in their own follicles into the scarred area.
The wonder of this is that the hair starts to regrow because it is still fed by the body’s blood vessels. Be prepared for multiple procedures though, because there may have been a significant lack of blood flow to the affected areas for varying lengths of time.
There are two basic types of successful transplants:
- Follicular unit transplantation (FUT) – where up to 4 or more hairs, containing nerves, sebaceous glands, and follicular units in a strip are transplanted at the same time.
- Follicular unit extraction (FUE) – using micro punches, surgeons take individual hair follicles one at a time. The upshot here is that it leaves almost no sign of extraction behind.
Either way, treatments for scarring alopecia are now available thanks to advances in technology and it has changed people’s lives.
If you are being adversely affected by scarring alopecia, or in fact, any kind of hair loss, you need a friend in the trichology field. However long it takes, you will not regret improving your condition alongside people who fully understand what you’re suffering and have extensive experience with this complicated condition.
In addition to training and exposure to hair loss, our team understand the emotional toll that these conditions take. We make every effort to ensure that you’re comfortable and feel safe from diagnosis to cure.
For your questions about alopecia, please feel free to contact the Fulham Scalp and Hair Clinic. Our team has a great deal of experience in treating all forms of hair loss and you can read the success stories for yourself.
Telogen effluvium is a temporary hair-shedding condition. It can occur alongside scarring alopecia as an increase in hairs entering the resting phase and subsequently falling out.
Yes, a compromised blood supply to the scalp can contribute to the development of scarring alopecia. Insufficient blood flow deprives hair follicles of vital nutrients and oxygen, leading to damage and eventual scarring.
Yes, scarring alopecia can manifest in different forms, such as frontal fibrosing alopecia, lichen planopilaris, central centrifugal cicatricial alopecia, and discoid lupus erythematosus. Each form has specific characteristics and patterns of hair loss.
Scarring alopecia can result in progressive and irreversible thinning, patches of baldness, receding hairline, and even complete loss of hair in affected areas. The types of hair loss can vary depending on the underlying form of scarring alopecia.
Inflammatory cells, particularly lymphocytes and macrophages, play a significant role in scarring alopecia. They infiltrate the hair follicles and surrounding tissues, causing inflammation and damage, ultimately leading to scar tissue formation.
A scalp biopsy is a diagnostic procedure that involves examining a small sample of scalp tissue under a microscope. It helps identify the presence of inflammatory cells, the degree of scar tissue formation, and the specific type of scarring alopecia affecting an individual.
Yes, scarring alopecia can affect hair growth in other areas of the body besides the scalp. It may cause loss or thinning of eyebrows, eyelashes, and body hair.
Performing a hair transplant on scar tissue caused by scarring alopecia is a complex procedure. Success rates can vary depending on the extent of scarring and the availability of healthy donor hair.
No, androgenetic alopecia is not a type of scarring alopecia. It is a common form of hair loss characterized by gradual, progressive thinning of the scalp hair, primarily influenced by genetic and hormonal factors.
Alopecia includes various conditions and factors related to hair loss. Besides scarring alopecia, it encompasses androgenetic alopecia, alopecia areata (patchy hair loss), telogen effluvium, trichotillomania (hair-pulling disorder), and other autoimmune or hormonal causes of hair loss.