What should you know about cicatricial hair loss?

Inflammation targets the follicle and can replace its growth structure with scar tissue. The scalp may look smooth or shiny where follicles have been lost, and hair may not regrow from those areas. Burning, tenderness, itching, redness, scaling, or small bumps can occur, although some people mainly notice a widening patch or reduced density. Hair loss can be uneven and may expand if the underlying inflammation remains active.

A scalp examination helps distinguish scarring hair loss from non-scarring conditions. Hair loss can also occur with alopecia areata, pattern hair loss, scalp ringworm, telogen effluvium, or traction alopecia; these conditions do not all damage follicles in the same way.

Arrange a dermatology appointment promptly, particularly when hair loss is accompanied by pain, itch, scale, redness, or pustules. The clinician may inspect the scalp closely and may recommend a biopsy or other tests to identify the inflammatory pattern. Treatment is directed at calming active inflammation and protecting remaining follicles; options depend on the diagnosis and your health.

Avoid tight hairstyles, harsh chemical processing, scratching, and unverified scalp products while the cause is being assessed. Photographing the scalp in consistent lighting can help you describe how the area changes. Hair restoration may be considered only after inflammation has been quiet for a suitable period; finasteride treatment is relevant to some other hair-loss patterns, not every scar-forming process.

Seek timely medical care for a rapidly enlarging patch, scalp pain, pus, crusting, bleeding, marked swelling, or fever. Urgent assessment is sensible when eye-area swelling, severe pain, or signs of a spreading infection accompany scalp changes. Do not wait for complete baldness before arranging evaluation, because treatment aims to preserve follicles that remain active.

Ask: Does the examination suggest scarring or non-scarring hair loss? Is a scalp biopsy needed? Which signs would show that inflammation is active? What treatment protects remaining follicles, and what side effects should I watch for? When would hair restoration be appropriate?