Scarring Alopecia: Causes, Symptoms, and Treatment Options

If you’re experiencing unexplained hair loss accompanied by scalp discomfort, redness, or flaking, you could be experiencing scarring alopecia. This form of hair loss causes permanent damage to hair follicles, making early diagnosis and treatment critical.

This guide will explore its causes, symptoms, treatment options, and whether hair restoration solutions like Bosley can help.

What Is Scarring Alopecia?

Scarring alopecia, also known as cicatricial alopecia, is a unique type of alopecia where inflammation permanently destroys hair follicles, replacing them with scar tissue. Unlike non-scarring alopecia, which allows for potential regrowth, hair loss from scarring alopecia is typically irreversible.

What Causes Scarring Alopecia?

Scarring alopecia occurs when inflammatory cells attack hair follicles, leading to permanent damage. While the exact cause isn’t always clear, several factors may contribute to the condition:

1. Autoimmune Disorders

Conditions such as lichen planopilaris and discoid lupus erythematosus cause the body’s immune system to mistakenly attack healthy hair follicles, resulting in scarring hair loss.

2. Chronic Inflammation or Scalp Infections

Bacterial, fungal, or viral infections can trigger an inflammatory response in the scalp, leading to follicle destruction. Folliculitis decalvans, a rare condition caused by chronic bacterial infection, is one example.

3. Genetic Predispositions

Certain genetic predispositions may make some individuals more prone to inflammatory scalp conditions. 

4. Environmental Factors

Environmental triggers, such as extreme stress, hormonal imbalances, or harsh chemical hair treatments, may also contribute.

5. Trauma or Physical Damage

Repeated tension from tight hairstyles, burns, or chemical relaxers can cause scarring, leading to central centrifugal cicatricial alopecia (CCCA.) This condition is most common in Black women.

6. Overactive Sebaceous Glands

Excess oil production can contribute to inflammation, creating an environment where hair follicles are more susceptible to damage and eventual scarring.

Symptoms and Early Warning Signs

Recognizing scarring alopecia in its early stages is crucial for slowing its progression. Common symptoms include:

• Redness, swelling, or tenderness on the scalp
• Burning or itching sensations before visible hair loss
• Flaking or scaling on the scalp
• Pustules or small bumps around hair follicles
• Gradual or patchy hair loss with smooth, shiny skin where hair once grew

Unlike androgenetic alopecia (male or female pattern baldness), which often results in a receding hairline or thinning crown, scarring alopecia may occur in patches or across the entire scalp.

If you’re noticing any of these symptoms, seek early medical intervention to help prevent further hair loss.

Scarring Alopecia Treatment Options

Although there is no cure for scarring alopecia, several treatment approaches can help manage the condition and improve scalp health. 

1. Medical Treatments

Topical Medications

• Corticosteroid creams or injections help reduce inflammation and slow follicular destruction.
• Calcineurin inhibitors like tacrolimus may help control immune system overactivity.
• Topical minoxidil (commonly used for pattern baldness) is less effective for scarring alopecia, but may improve blood circulation to the scalp.

Oral Medications

• Antibiotics or antifungals may be prescribed if hair loss is linked to infections.
• Immunosuppressants (e.g., hydroxychloroquine or methotrexate) can reduce immune-related inflammation.
• Anti-inflammatory drugs help manage pain and discomfort.

2. Surgical Solutions: Hair Transplants for Scarring Alopecia

For some individuals, a hair transplant may be a viable option—particularly if inflammation has been fully controlled.

Scarring alopecia transplants require specialized techniques because scar tissue has reduced blood supply, making it harder for transplanted follicles to survive.

At Bosley, experienced surgeons use advanced transplant methods like Follicular Unit Extraction (FUE) to achieve better success rates.

Book a free consultation with a hair restoration specialist to help determine if a hair transplant is right for you. 

3. Lifestyle & Natural Remedies

While natural treatments cannot reverse scarring, some lifestyle changes may support scalp health and reduce flare-ups:

• Anti-inflammatory diet: Incorporate omega-3-rich foods (salmon, flaxseeds) and antioxidants (berries, green tea) to combat inflammation.
• Gentle hair care: Avoid harsh shampoos, relaxers, or tight hairstyles that can aggravate the scalp.
• Scalp massages: Increase blood circulation and reduce tension.

Home remedies may provide some symptomatic relief, but professional treatment is often necessary to prevent worsening hair loss.

Expert Insights: When to Seek Professional Help

If you’re experiencing unexplained hair loss accompanied by scalp discomfort, redness, or flaking, consult a medical professional. A trichologist, dermatologist, or hair loss professional can help confirm the condition and develop a tailored treatment plan.

Schedule a free consultation with Bosley’s hair restoration experts.