Scarring alopecia (Cicatricial alopecia)

Scarring (cicatricial) alopecia is the category in which inflammation around the follicle destroys the stem-cell pool that maintains hair production. Once destroyed, the follicle cannot regenerate. The visible scalp shows smooth, shiny areas where pores (follicular ostia) are no longer visible.

This is the most urgent category of hair loss to identify, because anti-inflammatory treatment can halt progression but cannot reverse damage already done. Time matters.

Clues that suggest scarring alopecia rather than other types: itching, burning, scaling, pain, or tenderness in areas of loss; visible smooth areas without follicular openings; rapid progression in a localised distribution.

The main scarring conditions encountered in dermatology: lichen planopilaris, frontal fibrosing alopecia, central centrifugal cicatricial alopecia, folliculitis decalvans, dissecting cellulitis. Each has its own demographic pattern, distribution, and treatment approach.

Diagnosis requires dermatology assessment with trichoscopy and often a scalp biopsy. Treatment is anti-inflammatory (topical, intralesional, or oral) and requires long-term follow-up.