Other scarring alopecias

This group of alopecias includes disorders such as lichen planopilaris, folliculitis decalvans, cutaneous lupus erythematosus and central centrifugal cicatricial alopecia, which share a common outcome: irreversible destruction of the hair follicle. 

Signs and symptoms of scarring alopecias

These alopecias occur as areas of hair loss accompanied by local inflammatory signs such as:

• Skin redness (erythema).
• Perifollicular scaling.
• Small pus-filled lesions (pustules).
• Pain or discomfort.

Although exact symptoms depend on the type of alopecia. 

Over time, if inflammation persists, the skin in the affected area becomes smooth and thin, and the follicles disappear as scar tissue (fibrosis) forms. This is what prevents hair from regrowing. 

Given their scarring nature, early detection is essential to prevent further permanent hair loss. 

Causes of scarring alopecias

The causes are diverse and include immune system disorders, disturbances in the skin’s natural flora (microbiome), chronic infections, hormonal imbalances and genetic predisposition, although in many cases the exact cause remains unclear. 

Diagnosis of scarring alopecias

Trichoscopy is a key tool for identifying characteristic findings such as:

• Absence of visible follicular openings.
• Accumulation of cells and keratin around the follicle (perifollicular hyperkeratosis).
• Skin debris and sebum obstructing the follicles (keratin plugs).
• Arborising blood vessels.
• Broken hairs or signs of inflammatory activity. 

These findings help identify the specific subtype of alopecia and the degree of disease activity. 

Treatment of scarring alopecias

As scarring alopecias, the lost hair does not regrow, making it crucial to seek medical advice at the first signs of eyebrow or hair loss, so treatment can be started as early as possible to prevent progression.