Everything You Need to Know About Scarring Alopecia

If you’ve been diagnosed with alopecia (or suspect you have it), you may be wondering if your hair will grow back.

The answer depends on whether you have scarring alopecia or nonscarring alopecia. With scarring alopecia, the hair follicles are permanently damaged, so the hair most likely won’t return. With nonscarring alopecia, the damage to the hair follicles isn’t permanent, so the odds of hair regrowth are much higher.

Learning that you have scarring alopecia can be a lot to process, but there are ways you can slow or even stop hair loss. Here’s what you need to know.

Scarring alopecia is a permanent form of hair loss “where the scalp gets inflamed and, over time, the inflammation causes damage to the hair follicles, ultimately leading to their destruction,” says Victoria Barbosa, MD, MPH, director of the hair loss program at the University of Chicago and immediate past president of the Skin of Color Society.

You won’t see actual scars, though. “‘Scarring,’ when used in the term ‘scarring alopecia,’ refers to the replacement of normal skin structures — for example, the hair follicle, the sebaceous gland, blood vessels, nerves — with fibrous tissue,” says Paradi Mirmirani, MD, a board-certified dermatologist at Kaiser Permanente in Vallejo, California. “This process is known as fibrosis.” Once a hair follicle is destroyed and replaced by scar tissue, it cannot regrow hair, leading to permanent hair loss.

Other types of scarring alopecia can be hereditary or autoimmune, says Barbosa.

Your doctor will perform a physical exam to look for “a smooth appearance to the scalp skin,” says Dr. Mirmirani.

Sometimes doctors will remove a small piece of skin from your head, called a scalp biopsy, to confirm a diagnosis of scarring alopecia. “Under the microscope, we see follicles replaced by pink streaks of this fibrosis,” says Barbosa.

Scarring alopecia can progress over time. “In early stages, a few follicle openings might be missing, and the hair loss is subtle. In more advanced hair loss, the scalp might appear very smooth, with few retained follicles,” says Barbosa. “The hair loss might be limited to a small area, or it might involve a large area of the scalp. The scalp might also appear red or scaly.”

Unfortunately, there isn’t a cure for scarring alopecia, but there are things you can do to prevent further hair loss. “The most important step that a person can take to minimize the effects of scarring alopecia is to receive a proper diagnosis as early as possible,” says Barbosa, especially if you have any burning or itching alongside your thinning hair. “It is easier to prevent additional hair loss than it is to regrow hair, especially in scarring alopecia. So starting treatment early is critical,” she says.

You may want to opt out of hair transplants or platelet-rich plasma injections, too. “These are procedures that are not appropriate for everyone with scarring alopecia, are expensive, and do not guarantee results,” says Mirmirani.

Some people with scarring alopecia might consider scalp micropigmentation, which is “a procedure where small tattoos are made in the scalp to give the appearance of having more hair,” says Barbosa.

Make sure any cosmetic approaches you use to cover up hair loss, such as extensions and hairpieces, are nonirritating. “Any cosmetic option that may put tension on the hair is not advised, out of concern for causing additional inflammation or damage,” says Mirmirani.

Barbosa says it’s also generally best to avoid adhesives, such as glue, to install wigs, because they may contribute to additional hair loss.

If you decide to use a cosmetic approach to cover up any hair loss, make sure you talk through the pros and cons of it with a trusted healthcare provider first.

• Scarring alopecia is a category of permanent hair loss typically caused by inflammation that destroys hair follicles and results in a smooth, bare-scalp appearance.
• While there is no cure, there are treatments available — typically anti-inflammatory medications — that can slow or stop the progression of scarring alopecia.
• Some people with scarring alopecia might opt for cosmetic approaches to masking hair loss, such as scalp micropigmentation or wigs.