Inflammation
Scalp burning, tenderness, itching, or red or discoloured patches.
Home › Hair Problems › Scarring Alopecia
Cicatricial alopecia · inflammation of hair follicles · Dehradun
Hair loss with burning, redness or shiny patches? Scarring alopecia needs early diagnosis.
Painful scalp · redness/scale · loss of follicular openingsScarring alopecia, also called cicatricial alopecia, occurs when hair follicles are permanently damaged and replaced by scar tissue. In many forms, ongoing inflammation causes this damage. Some cases cause itching, burning, tenderness, scale or pustules; others progress quietly. Treatment is directed at stopping further destruction, not promising regrowth in completely scarred areas.
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Illustrative medical image. The appearance can vary; an examination is needed for diagnosis.
Recognise the pattern
Common signs of scarring alopecia
These clues help distinguish one kind of hair loss from another—but images and symptoms alone cannot confirm a diagnosis.
Perifollicular scale
Scales or redness concentrated around emerging hairs.
Smooth patches
Shiny areas with reduced or absent follicular openings.
Progression
An expanding patch or front hairline moving backwards.
Understand the cause
Why is scarring alopecia different from ordinary hair loss?
In male and female pattern hair loss the follicles miniaturise, and in alopecia areata they usually remain intact. In scarring alopecia, inflammatory injury can replace a follicle with fibrous tissue. Once a follicle is destroyed, medication generally cannot make hair grow from that site again.
Important forms include lichen planopilaris, frontal fibrosing alopecia, discoid lupus of the scalp, central centrifugal cicatricial alopecia and some destructive folliculitis disorders. Their treatments differ, so a precise diagnosis matters.
Recognise the different patterns
Common types of scarring alopecia
Scarring alopecia is a group of conditions, not a single diagnosis. The pattern of hair loss, inflammation and symptoms helps guide assessment and treatment.
Lichen planopilaris
Irregular patches of hair loss with redness or scale around hair follicles; itching, burning or tenderness may occur.
Frontal fibrosing alopecia
Gradual recession of the frontal or temple hairline, sometimes accompanied by thinning or loss of the eyebrows.
Discoid lupus of the scalp
Inflamed, scaly patches that may leave lighter or darker skin changes and permanent scarring hair loss.
Folliculitis decalvans
Repeated scalp pustules or crusting, sometimes with several hairs emerging together from one follicular opening (tufting).
Dissecting cellulitis of the scalp
Painful, swollen scalp nodules or boggy areas that can discharge pus and eventually cause scarring.
Central centrifugal cicatricial alopecia
Hair thinning and loss that often starts around the crown and gradually spreads outward, sometimes with itching or tenderness.
These appearances can overlap. A dermatologist may use trichoscopy and, when indicated, a scalp biopsy to identify the cause before selecting treatment.
Diagnosis first
How a dermatologist evaluates it
History and scalp examination guide the need for trichoscopy, a biopsy, or targeted tests (such as bacterial or fungal testing when infection is suspected). Not everyone needs every investigation.
Careful scalp examination
Look for loss of follicular openings, perifollicular erythema/scale, pustules, changes at the front hairline and eyebrow involvement.
Trichoscopy
Identify active inflammatory areas and guide selection of a biopsy site.
Scalp biopsy when indicated
A biopsy from an actively inflamed area, often near the edge rather than the fully scarred centre, may help identify the subtype and guide treatment.
What happens during a scalp biopsy?
If a biopsy is needed, a small sample of scalp skin (often around 4 mm) is usually taken under local anaesthesia from an active area near the edge of hair loss rather than the middle of an old scar. A stitch may be required, and a small mark or scar can remain. The tissue is examined under a microscope; results are interpreted together with scalp examination and trichoscopy to guide diagnosis and treatment. Not every patient needs a biopsy.
Evidence-informed care
Treatment options — chosen for the diagnosis
Management depends on the actual condition, its severity, age, medical history and your goals. Procedures are not a replacement for treating the underlying cause.
Stop ongoing follicular damage
The main goal is controlling inflammation and preventing additional permanent hair loss. Early treatment is especially important.
Anti-inflammatory treatment
Depending on the subtype, treatment may include topical/injected corticosteroids, other anti-inflammatory agents or prescription systemic medicines with appropriate monitoring.
Treat associated factors
Assess pustules or possible infection, review damaging hair-care practices where relevant, and manage associated scalp symptoms. Not every scarring disorder is autoimmune.
Regrowth expectations
Completely scarred follicles are unlikely to regrow. Minoxidil may help surviving neighbouring follicles in selected patients but does not treat active scarring inflammation by itself; PRP/GFC is not a substitute for anti-inflammatory care.
When to seek an earlier appointment: A spreading bald patch with pain, burning, redness, pustules, scale, eyebrow loss or shiny skin is a reason to seek prompt dermatology assessment—not months of trial-and-error hair products.
Realistic expectations
What follow-up usually looks like
The aim is to stop additional follicle damage. Follow-up checks whether inflammation is settling and hair loss has stabilised; visible regrowth is not expected in areas where follicles have already scarred.
As soon as suspected
Avoid delay: investigate active inflammatory hair loss promptly.
During treatment
Monitor symptoms, scalp inflammation, progression and treatment adverse effects.
Long-term follow-up
Aim for disease inactivity; remaining hair can often be protected better than already scarred sites restored.
Clinical photographs
Comparable photographs of the same scalp areas help show whether patches or the hairline are changing over time.
Trichoscopy and examination
Reduction in redness, scale, pustules and other signs of active inflammation can suggest better disease control.
Symptoms and progression
Itching, burning, tenderness, new patches and hairline changes are reviewed. Some disease can progress without symptoms.
Treatment safety
If prescription medicines are used, the dermatologist also checks tolerability, possible adverse effects and any necessary monitoring tests.
What counts as treatment success? No new areas of hair loss, less inflammation and preservation of remaining hair can be successful outcomes—even when permanently scarred areas cannot regrow.
Common patient questions
Scarring Alopecia FAQs
Clear answers without unrealistic promises or one-size-fits-all treatments.
Can hair regrow in scarring alopecia?
Hair follicles already replaced by scar tissue generally cannot regrow. Treatment aims to preserve follicles that remain.
What are common types?
Examples include lichen planopilaris, frontal fibrosing alopecia, discoid lupus and several destructive folliculitis conditions.
Why might I need a scalp biopsy?
Different subtypes can look similar. Tissue from an active margin may clarify the pattern of inflammation and guide treatment.
Does everyone have itching or pain?
No. Some conditions can progress with few symptoms, so visual change itself is important.
Can minoxidil alone stop it?
Usually not. Active cicatricial alopecia needs treatment of the underlying inflammation; minoxidil may only support surviving follicles in selected patients.
Are hair transplants useful?
Transplantation is generally not a first step during active disease and may be inappropriate. Any consideration requires prolonged disease stability and specialist counselling.
Patient education, not a personal prescription.
Do not begin or discontinue prescription treatments solely from a webpage. A dermatologist can identify overlapping disorders and discuss benefits, contraindications and follow-up. All clinical images on this page are AI-generated illustrations—not photographs of patients or treatment results.
Clinical reading: DermNet: scarring alopecia on trichoscopy · AAD: frontal fibrosing alopecia
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Dr Neeraj Garg · MBBS (IMS-BHU), MD (IMS-BHU)
Maheshwari Hospital, Dalanwala, Dehradun · Consultation ₹800