What are the risk factors for scarring alopecia?

Scarring alopecia, also called cicatricial alopecia, occurs when inflammation injures the follicle and healing replaces part of it with scar tissue. The affected follicle may stop producing a normal hair. Different forms include frontal fibrosing alopecia, central centrifugal cicatricial alopecia, folliculitis decalvans, and lichen planopilaris.

Possible clues include gradually widening areas of hair loss, smooth or shiny scalp, reduced follicle openings, itching, burning, tenderness, redness, scaling, pustules, or a receding hairline. Traction from tightly pulled styles, chemical irritation, burns, and other scalp injuries may add physical damage, but hair loss has many non-scarring causes too.

Arrange an assessment if shedding is accompanied by scalp discomfort, redness, scale, pustules, or areas that look smooth and shiny. Use gentle hair care, avoid tight hairstyles and repeated tension, and pause irritating chemical treatments while the scalp is inflamed. Do not scratch or pick crusts.

A dermatologist may examine the scalp closely and sometimes recommend a biopsy to identify whether follicles are being destroyed. Treatment aims to calm active inflammation and protect remaining follicles; regrowth is not expected from a follicle that has been replaced by scar tissue.

Seek prompt dermatology care for rapidly expanding hair loss, painful or burning scalp, pus-filled bumps, bleeding, marked redness, or a receding hairline with eyebrow loss. Earlier review can help distinguish scarring alopecia from temporary shedding and identify active inflammation before more follicles are affected.

Ask whether the follicles look scarred, whether a biopsy is needed, which hair practices may be worsening irritation, and how treatment will be monitored over time.