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 AlopeciaScarring 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.
Scarring Alopecia’s Big SurprisePossibly 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 AlopeciaThere 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 AlopeciaFocussing 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
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 scarring alopecia.) 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 scarring 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, or body, 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.
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.