What should you know about secondary scarring alopecia?

Scarring alopecia means inflammation or injury has damaged the follicle and replaced part of its normal structure with scar tissue. Secondary forms can follow burns, infections, surgery, trauma or severe inflammation. The skin may look smooth and shiny, with fewer visible follicle openings; itching, tenderness, scale or pustules can also occur.

The pattern and history help distinguish this problem from non-scarring shedding. A dermatologist may examine the scalp closely and sometimes take a small biopsy. Finding ongoing inflammation matters because early treatment can help protect follicles that remain active.

Arrange a dermatology assessment when a bald patch is enlarging or the scalp is persistently uncomfortable. Keep hair care gentle: avoid tight styles, harsh chemicals, scratching and repeated heat on affected skin. Treatment depends on the cause and may include anti-inflammatory medicine, infection treatment or an intralesional steroid injection for selected inflammatory areas.

You can read about [Frontal Fibrosing Alopecia](/conditions/frontal-fibrosing-alopecia/), [Bald Patches](/symptoms/bald-patches/) and [Steroid Injection Into The Skin](/treatments/injectables/intralesional-steroid-injection/).

Seek prompt review for rapidly expanding hair loss, pus, bleeding, marked pain, fever, or a scalp that is hot and swollen. Sudden loss of eyelashes or eyebrows, or changes around the hairline, should also be assessed. Urgent care is appropriate for severe swelling with breathing difficulty or signs of a serious infection.

Ask whether the follicles show active inflammation, whether a biopsy is useful, and what cause is most likely from your history. Discuss the aim of treatment, possible effects on remaining hair, scalp-care advice, and whether cosmetic options should wait until the condition is quiet.