Scarring Forms of Hair Loss
Written by Dr. Griffin
When we speak of hair loss disorders at Philadelphia’s Griffin Hair Restoration, we talk about scarring versus non-scarring forms. Most forms of hair loss are non-scarring. These include inherited pattern hair loss, which occurs under the influence of hormones and genetic predisposition, and alopecia areata, which is a temporary autoimmune form of hair loss. Telegenic effluvium refers to temporary shedding—usually due to a stressor, either physical or psychological. Non-scarring hair loss can be reversed with treatment or resolves on its own and regrows.
Scarring hair loss is caused by inflammation that destroys the follicle, leaving behind a scar. Some forms are autoimmune, such as lupus-induced hair loss, and others may be the result of chemical or physical damage to the follicles. Perming, straightening, and tight braiding can lead to scarring hair loss.
A common form of scarring hair loss that we see is called lichen plano pilaris (LPP). It has several forms, one of which is called FFA (frontal fibrosing alopecia). In FFA, white blood cells attack the follicles along the hairline and kill them, leaving a scar. The cause of this disorder is currently unknown. Treatment goals are to try to save residual follicles by stopping the inflammation. Topical steroids and PRP (platelet-rich plasma) can be used. At some point, the inflammation subsides and goes into remission. In some cases, hair transplantation can be considered, however the risk exists that the inflammation may attack the new grafts, so caution is required.
We often need to do a scalp biopsy to accurately diagnose scarring hair loss. This is a simple office procedure. Early diagnosis and treatment are essential to ensure the survival of the remaining hair.
Good hair and scalp care are important to understand in order to prevent chemical and mechanical damage to follicles. As a hair transplant doctor, Dr. Thomas Griffin discourages the use of straightening and chemical perms. Tight braids and ponytails cause traction on the follicle, leading to damage. Heavy oils and pomades may occlude follicles and cause folliculitis, which can destroy a follicle.
In summary, scarring hair loss is permanent. Early diagnosis, stoppage of chemical and mechanical stress, and early treatment are paramount.
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