Alopecia

 

Alopecia

 

Among the common people, alopecia is not widely known word. It is a medical term, which is used for hair fall problem. Hair fall itself is a disease. But sometimes it is seen as symptoms of other diseases. Sometimes some drugs cause it. But these type of hair fall is temporary. After a while, it is cured naturally. In this article, I will discuss alopecia as a disease itself.

 

Type of alopecia

 

Male pattern baldness

 

It is the most common type of alopecia that occurs with male. It is caused due to hormonal disorder that lies in androgen of male sex hormone. People with male pattern baldness are typically shown with round patches.

 

Female pattern baldness

 

Female pattern baldness is same as the male pattern alopecia that affects the woman.

 

Alopecia Areata

 

You may have seen some people with a few round patches on the scalp. Normally these round patches are results of alopecia areata. In some cases of alopecia areata, affected people lose their all hair from the scalp. The factor that are responsible for Alopecia areata are mainly genetic. It is widely proved that a affected person had family history of having this disease. Tension and stress is another fact that causes alopecia areata to some people.

 

Scarring Alopecia

 

When the hair follicles are destroyed and hair does not grow back is generally occurred due to scarring alopecia. It also can happen as a side effect of some disease.

 

Anagen and Telogen Effluvium

 

A patient of cancer treated by chemotherapy loses his hair as side effect of that treatment. It is commonly known as anagen effluvium type of hair fall. On the otherside Telogen, effluvium is the result of stress and some drugs.

 

Treatment of Alopecia

 

Generally, there is no effective treatment for alopecia areata. Bu some hair proves effective in growing hair back. Minoxidil and Finasteride brings some effective result in growing hair. Although the effectiveness does not stay after stopping the dose of this drugs. Hair lose can be treated by cosmetic surgical methods. You can use wigs hairpieces to cover up your hair scalp. There are also some type of treatment that are expensive too. You can go for surgery, hair transplant. In hair, transplant process a skin of full of hair and follicles is removed and transplanted onto the scalp.

 

Most importantly alopecia can be handled by controlling your emotion and stress levels balance diet, cheerful lifestyle etc.

 

Is alopecia a type of cancer?

 

Many people ask the question, whether alopecia is a type of cancer or not. Short answer may be misleading. In some cases alopecia is closely related to cancer but alopecia is not cancer. Cancer treatments like chemotherapy and even cancer itself may cause alopecia. On the other hand excessive hair growth in any area may be a sign of cancer.

 

Before discussing relation between alopecia and cancer, I think it would be better to write few words about alopecia, cancer, hair loss and hair regrowth.

 

What is Alopecia?

 

In simple words among medical professionals hair loss is known as alopecia. So when someone talks about alopecia s/he is talking about hair fall or hair loss. There is another point to note, hair fall and hair regrowth is part of normal process. Average adults have 100,000 to 150,000 hairs and they lose around 100 hairs a day which is completely normal. If hair fall rate is high then there is real cause to be concerned. It’s known as alopecia. There may be several reasons for alopecia including skin disease, chemotherapy, which I will discuss little later.

 

Cancer

 

Cancer is a disease which can be deadly if not treated early and properly. Before defining cancer I would like to write few words about cell. We all know that cell is the basic unit of living thing. It is estimated by scientists that average human body has around 10 trillion cells. We lose around 1 million skin cells in a day. So it’s clear that dying and reproduction of cells is a continuous life long process.

 

In case of cancer our cells are reproduced uncontrollably and cancerous cells may attack healthy cells. That means your healthy tissue and organs may be attacked. This is why cancer is so dangerous if cancerous cells are not killed early.

 

But killing cancerous cells is not easy. Anti cancer drugs often have severe side effects including hair fall. Radiotherapy is another method used to kill cancerous cell and radiotherapy may also cause hair fall.

 

I think you are starting to get an idea, how alopecia is related to cancer, though alopecia itself isn’t cancer. More on that later.

 

Hair Loss and Regrowth

 

As I mentioned above alopecia is synonym of hair loss and I have already discussed in brief about alopecia, let’s discuss about hair regrowth. Actually our hair is a type of protein called keratin. It is produced in a small anatomical sack called follicle. By producing keratin follicles continue to push hair strings outward and hair continues to grow. But these follicles on our scalp have a life cycle. At any time around 10% follicles are in resting phase and hairs from those follicles starts to fall. After the resting phase follicle become active again and hair starts to grow. We never see bald guy because 90% of follicles are always in active phase. But the problem is many diseases, hormone imbalance, cancer treatment including chemotherapy & radiotherapy and some types of cancer itself (source) may affect follicles which may lead to alopecia.

 

Alopecia and Cancer Treatment

 

Alopecia isn’t obvious in chemotherapy. Several drugs are used as part of cancer treatment; some drugs cause hair thinning, some cause partial hair loss or loss of patches of hair and some cause total hair loss. Luckily there are some drugs which do not cause hair loss at all and complete hair loss is very unlikely. Hair fall is one of the side effects of anti cancer drugs and intensity of side effects including hair fall varies person to person. Doctors decide which drug or drugs are most suitable for cancer treatment of a specific patient. But in some cases there are some options and patients may discuss which drugs are less likely to cause hair fall. It’s very difficult to guess about side effects early. Some anticancer drugs doesn’t cause hair loss and on the other hand there are some anticancer drugs which may cause total hair loss including underarm, eyelashes, eyebrows and pubic hair.

 

In most cases Hair comes back

 

Usually hair fall begins within two to three weeks of chemotherapy but it regrows after completing the treatment. During the period you can use wig, scarf, hat or something like these.

 

Alopecia due to Cancer

 

When we discuss about alopecia and cancer, we usually talk about hair loss as side effect of cancer treatment. But there are some types of cancer like mycosis cutaneous lymphoma, fungoides and Sézary syndrome which may also cause hair fall.

 

 

What Causes Alopecia Areata

 

Alopecia areata causes hair fall in small or random patches. It is an autoimmune disease. When immune system attacks the hair follicles is when Alopecia develops. Hair loss caused by alopecia areata affects the scalp. Other parts of the body can also be affected. The disease usually does not cause total hair loss. It can block hair from growing back. The hair loss related with alopecia areata is unpredictable. How many hair falls or regrows can vary from person to person. The exact cause of alopecia is yet to be known. However, in many cases, people who have other autoimmune issues such as rheumatoid arthritis or type 1 diabetes are particularly vulnerable to Alopecia areata.

 

Symptoms of Alopecia Areata

 

Hair loss is the main symptom of alopecia areata. Hair falls out in small patches on the scalp. The patches are typically several centimeters or less. You may notice clumps of hair in the shower or on the pillow. As hair loss in similar pattern can be caused by other types of diseases, alopecia areata should not be diagnosed by hair loss alone.

 

More extensive hair loss can also occur in rare cases. This however is typically an indicator of other types of alopecia including alopecia totalis and alopecia universalis. Alopecia totalis involves total hair loss on the scalp. Alopecia universalis involves hair loss on the entire body.

 

Causes Alopecia Areata

 

Alopecia areata develops when the immune system confuses healthy cells or hair follicles with foreign substances. Typically, the immune system defends body against foreign invaders such as bacteria and viruses. When alopecia areata occurs, the immune system attacks hair follicles mistakenly. Hair grows from hair follicles. Due to attack by the immune system, hair follicles get smaller and cease to produce hair, resulting in hair loss.

 

What causes the immune system to attack hair follicles is still unknown to researchers. However, as people with family history of autoimmune diseases are more prone to alopecia areata, researchers believe that genetic reason may be linked with development of alopecia areata. Researchers also believe that apart from genetic reason, certain factors in environment are also needed to cause alopecia areata.

 

Diagnosing Alopecia Areata

 

A doctor can review symptoms and determine if you have alopecia areata. Looking at the extent of hair loss and examining hair samples under a microscope can help doctors diagnose alopecia areata. In order to rule out other conditions for hair fall such as fungal infection, a doctor can also perform a scalp biopsy. Your doctor will take a small piece of skin off your scalp, during a scalp biopsy for analysis.

 

In case other autoimmune conditions are suspected, blood test may be done. The type of disorder your doctor suspects determines the type of blood test to be done. Your doctor may test to determine presence of abnormal antibodies. In case of presence of autoantibodies in your blood, it typically indicates that you have an autoimmune disorder. In order to rule out other conditions, doctors may conduct other blood tests that are as follows.

 

  • Antinuclear Antibody Test
  • Thyroid Hormones
  • Follicle Stimulating and Luteinizing Hormone
  • Free and Total Testosterone
  • Iron Level
  • C-reactive Protein and Erythrocyte Sedimentation Rate (ESR).

 

Treatment for Alopecia Areata

 

Cure for alopecia areata is still unknown. The condition, however, is treatable. Treatment may help block future hair loss and regrow hair quickly.

 

Medical Treatment

 

Medications such as minoxidil (Rogaine) can be applied to the scalp to stimulate hair growth. There are other therapies including corticosteroid cream or ointment and steroid injections. Photo chemotherapy may also be used to boost hair growth, in some cases. It is a kind of radiation treatment that uses a combination of ultraviolet light and oral medication.

 

Alternative Therapies 

 

Some people rely on alternative therapies to treat alopecia areata. These therapies include acupuncture, vitamins, herbal supplements, aromatherapy etc. Most of the alternative therapies have not been tested in clinical trials. Effectiveness of these therapies remains unknown.  

 

Some steps can help minimize discomfort. Applying sunscreen is useful to protect exposed areas from sunburns. In cases, eyelashes have fallen out; wearing sunglasses can help shield eyes from sun and dust. Wearing a hat, wig or scarf can help protect the scalp.

 

The effectiveness of different treatments can vary. In cases of some people, hair grows back on its own, needing no treatment. In some cases, people do not see any improvement despite going for every treatment option. In such cases, trying more than one treatment option at a time may help see a difference. It is good to keep in mind that hair regrowth may only be temporary. The hair that regrows can fall out again.

 

Coping with Alopecia Areata

 

Alopecia areata can be hard to deal with emotionally, especially when the whole scalp is affected by hair loss. People may feel depressed or isolated due to the condition. In such cases, support groups or counselors may help you cope with the effects of the disease. Support groups can provide environment for you to express anxiety or stress to feel better. The National Alopecia Areata Foundation (NAAF) has such support groups in the United States. These groups meet in various places. The NAAF also has online message boards and conferences to help people connect with each other.

 

 

Different types of Alopecia Areata

 

Alopecia areata is an autoimmune disorder. The immune system mistakenly confuses hair follicles with foreign substances, attacks the hair follicles and causes hair fall. It causes patchy hair loss. It can range from mild to severe form.

 

Different forms of Alopecia Areata

 

There are three main types of Alopecia areata including alopecia areata (patchy), alopecia totalis and alopecia universalis.

 

Alopecia Areata (Patchy)

 

It involves patchy hair loss rather than hair loss in the entire area on scalp or other parts of the body it occurs on. Hair loss patches can be on the scalp or other parts of the body that grow hair such as the eyebrows, beard, eyelashes, hands, legs and arms. This type has chance to convert into alopecia totalis or alopecia universalis.

 

Alopecia Totalis

 

It causes a person to lose most or all of the hair on the scalp.

 

Alopecia Universalis

 

Alopecia universalis is at more advanced level than alopecia totalis. It involves hair loss on the entire body.  

 

There are also other forms of alopecia areata that are as follows.

 

Diffuse Alopecia Areata

 

Diffuse alopecia areata involves sudden thinning of the hair all over the scalp. It is usually hard to diagnose as it looks like other forms of hair loss including telogen effluvium or female or male pattern hair loss.

 

Ophiasis Alopecia

 

Ophiasis alopecia areata involves a unique pattern of hair loss that occur on the sides and lower back of the scalp, in the shape of a band. This condition is harder to treat as it doesn’t respond to medication quickly.

 

Following are few other types of alopecia.

 

Alopecia Barbae

 

Alopecia barbae is a type of alopecia areata, which is localized to the beard area. It can cause extensive hair loss across the entire beard area or a single bald patch.

 

Androgenetic Alopecia (AGA)

 

Androgenetic alopecia is also known as male or female pattern baldness. It involves thinning of hair in both men and women. It is the most commonly experienced type of progressive hair loss. The cause for this type of hair loss is thought to be hereditary.

 

Scarring Alopecias (Cicatricial Alopecias)

 

Scarring alopecias involves a group of rare disorders that cause permanent hair loss. It is also known as cicatricial alopecias.

 

Traction Alopecia

 

Traction alopecia gets caused by excessive pulling or tension on hair shafts as a result of certain hair styles. It is experienced mostly by women, particularly those of Afro-Caribbean and East Indian origin. The way the hair gets pulled determines hair loss. Prolonged traction alopecia can cause new hair follicles to stop developing and result in permanent hair loss.

 

Hair loss and regrowth can be unpredictable regardless of types of alopecia areata. In cases of some people, hair may regrow and not fall out again. There is no known cure for alopecia areata. Nonetheless, hair follicles remain alive in case of any type of alopecia areata. This leaves hope for hair regrowth any time in future.

 

There are different treatment options for different types of alopecia areata. Seeing a doctor and having a diagnosis can help determine the type of alopecia areata you may have and the type of treatment needed.

 

 

Is Alopecia contagious in Humans?

 

Alopecia rarely occurs due to infection. Thus, it is not generally considered to be a contagious condition. Nonetheless, there is an exception, which is a patch of hair loss caused by ringworm of the scalp. Ringworm is a kind of fungal infection, like athlete’s foot. It grows slowly on the skin.

 

It usually does not occur on the head. Sometimes it occurs on the scalp of a child that has pet animal with the same problem. This condition is not hard to treat. As this condition is uncommon these days, proper diagnosis is necessary. A skin specialist can diagnose it by examining the scalp.

 

Can Alopecia just go away?

 

Alopecia is a very unpredictable disease. Sometimes it just goes away on its own. The reason behind this is unknown. When it goes, it may or may not come back. It can appear at childhood or any age. It can disappear for decades and then resurface again. In some cases, it goes away and never returns.

 

Cicatricial Alopecia

 

Cicatricial alopecias can be of two types. One is primary and the other one is secondary. In case of primary cicatricial alopecia, destructive inflammatory process causes damage to hair follicles. In case of secondary cicatricial alopecia, hair follicles get targeted by external issues like burns, severe infections, radiation or tumors. The discussion below is focused on primary cicatricial alopecia.

 

Primary cicatricial alopecia is about different types of rare disorders that ruin hair follicles, alter them with scar tissue and cause permanent hair loss. Hair fall can keep occurring gradually without symptoms and remain unnoticed for long periods. In some cases, the hair fall may occur alongside severe itching, pain and burning. It can progress rapidly. Both men and women with good health and of all ages can experience cicatricial alopecia.

 

Signs and Symptoms

 

There are signs of cicatricial alopecia that show up on the affected areas of the scalp. There may be redness, decreased or increased pigmentation, scaling, pustules, or draining sinuses. In some cases, there may be little sign of inflammation. The follicles that get destroyed by inflammation are below the skin surface. There is typically no scar on the scalp. The affected scalp is typically hairless and smooth without the usual pore markings.

 

The type of inflammatory cells that ruin the hair follicles during the active stage of the disease, classify cicatricial alopecias. Neutrophils or lymphocytes may get involved with the inflammation.

 

Cicatricial alopecias where lymphocytic inflammation gets involved predominantly, include frontal fibrosing alopecia, lichen planopilaris, pseudopelade (Brocq) and central centrifugal alopecia. Tufted folliculitis and folliculitis decalvans are cicatricial alopecias that get caused mainly by neutrophilic inflammation. In some cases, the inflammation can shift from predominantly neutrophilic process to lymphocytic process. Folliculitis keloidails and dissecting cellulitis are cicatricial alopecias with a mixed inflammatory infiltrate.

 

Causes

 

The reasons behind various cicatricial alopecias are not well understood. Inflammation involved in all types of cicatricial alopecias, is aimed at upper part of the hair follicles, where the sebaceous or oil glands and stem cells are positioned. In case, the sebaceous glands and stem cells get destroyed, it leaves no possibility for regeneration of the hair follicles, resulting in permanent hair loss. Cicatricial alopecias are not transmittable.

 

Affected Populations

 

Cicatricial alopecias can affect anyone regardless of gender and age. However, children usually do not experience cicatricial alopecias. Even though cicatricial alopecias occur worldwide, they are generally not very common.

 

In most cases, people that experience cicatricial alopecia do not have a family history of a similar condition. Women of African ancestry most commonly get affected by central centrifugal alopecia. Dark-skinned men are primary target of dissecting cellulitis which looks like deep cystic acne involving the scalp. While hair loss condition can be of different types, non-scarring forms of hair loss usually do not turn into scarring forms of hair loss. 

 

Diagnosis

 

The first step in diagnosing cicatricial alopecia is a scalp biopsy. Type of inflammation, amount of inflammation, location and other changes in the scalp are the typical findings that helps determine the type of cicatricial alopecia, degree of activity and appropriate therapy.

 

A biopsy punch gets used to take the biopsy specimen. A biopsy punch is an instrument that removes skin as a sample about the shape and size of a small pencil eraser, after using local anesthesia. Usually one or two biopsy specimen are taken. Before examination, the skin sample gets sectioned both vertically and horizontally.

 

It is also important to do clinical evaluation of the scalp. Ongoing activity can get signaled by symptoms of itching, burning, pain, or tenderness. Pustules, scaling and redness are signs of scalp inflammation. In some cases, there may be very few signs or symptoms. In such cases, scalp biopsy is the only option that can demonstrate the active inflammation. Alongside the biopsy findings, the overall pattern and extent of hair loss enable the dermatologist to diagnose the specific type of cicatricial alopecia. In order to find out areas of active disease, a hair pull test can be performed. Hair follicles can pull out easily in the areas of active disease. The pulled hairs get examined to determine how many are anagen or growing hairs and how many are telogen or resting hairs. Usually, telogen hairs pull out easily. In the area of active scarring alopecia, anagen or growing hair can also pull out easily. Furthermore, when pustules are present, cultures may get performed to identify which microbes may be contributing to inflammation. A thorough examination that is inclusive of all the necessary parameters is important in diagnosing a cicatricial alopecia, finding out features in individual patients, all of which in turn will help select the right therapy. For evaluation, it is important to involve a dermatologist with special expertise in hair or scalp disorders, and who is familiar with latest diagnostic methods and therapies.

 

Standard Therapies

 

Predominant inflammatory cells that attack the hair follicles can be of different types, which help classify primary cicatricial alopecia. Treatment strategies can vary for different subtype and individuals.

 

Anti-inflammatory medications get used in treating lymphocytic group of cicatricial alopecia including pseudopelade (Brocq), central centrifugal alopecia, frontal fibrosing alopecia and lichen planopilaris. The treatment aims at eliminating the lymphocytic inflammatory cells that are ruining the hair follicles. Oral medications that may be used include dosycycline, hydroxychloroquine, mycophenolate mofetil, cyclosphorine, or pioglitazone. Topical medications may include topical tacrolimus, corticosteroids, topical pimecrolimu, derma-smoothe, etc. Triamcinolone acetonide is injectable into symptomatic or inflamed areas of the scalp.

 

Treating neutrophilic group of cicatricial alopecias is aimed at removing the predominant microbes that are involved in the inflammatory process. Oral antibiotics are the central component of therapy. Oral antibiotics can get supplemented by topical antibiotics and anti-inflammatory medications.

 

Antimicrobials, anti-inflammatory medications and isotretinoin can be used for treatment of mixed group of cicatricial alopecias.

 

Treatment

 

Treatment of cicatricial alopecia gets prolonged typically. Until signs and symptoms of scalp inflammation are decreased and progress of the condition has been controlled, the treatment has to be continued. Current treatments can usually control itching, burning, pain, tenderness, scaling, scalp redness and pustules. Sadly, the progress of the hair shedding may continue even when the signs and symptoms are gone. Cicatricial alopecia my reoccur after a quiet period. In such case, treatment has to be repeated.

 

Once the disease has been inactive for two years or longer, surgical treatment can be an option for cosmetic benefit. In such cases, scalp reduction or hair restoration surgery may be considered.

 

When the hair follicles are destroyed, hair will not regrow. The good thing is that it may be possible to treat inflammation in and around hair follicles before they get destroyed. That is why it is important to begin treatment as early as possible to beat the inflammatory process. Additionally, applying minoxidil (2% or 5%) to the scalp twice daily may be useful in stimulating any small, remaining and unscarred follicles. The progress of hair fall is unpredictable. Progress can be slow and minimal in some cases. Progress can also be rapid and extensive in other cases. Typically, sufficient hair remains to cover the affected areas of the scalp.

 

Hair pieces like hats, wigs and scarves are all safe. They will not worsen your condition. Hair care products or shampoos are usually safe as long as they are non-irritating to the scalp. It is good to consult a dermatologist regarding use shampoos or other hair care products.

 

Scarring Cicatricial Alopecia

 

The term scarring alopecia or cicatricial alopecia is about various and uncommon disorders that ruin hair follicles and related sebaceous glands, leading to permanent hair loss. Both men and women can experience scarring alopecia, even though women more commonly suffer the problem.

 

The destructive process is unpredictable and may or may not be symptomatic. For instance, the hair fall can be gradual with no symptom, in some cases. As a result, hair fall can remain unnoticed for a long period. The hair fall can also be rapidly progressive and linked with itching, burning and pain.

 

As the inflammation that ruins the follicles is underneath the skin surface, scalp usually does not have a visible sign or scar. Rather what is visible is a shiny and smooth area devoid of hair follicles. In the affected area, there is very little or almost no sign of inflammation. The inflammation can however be marked less commonly, with the patient experiencing scaling, redness, draining sinuses and pustules and decreased or increased pigmentation.

 

Causes

 

The reasons behind diverse cicatricial alopecia are not fully understood by researchers yet. However, inflammation is involved in all types of cicatricial alopecias. Inflammation targets the upper part of the hair follicles where the sebaceous glands and stem cells are located. In case, the sebaceous glands and stem cells are destroyed, the hair follicles have no possibility to regenerate, resulting in permanent hair loss.

 

Affected People

 

Both women and men can experience cicatricial alopecia at any age. Usually children do not experience this problem. Central centrifugal alopecia is a type of cicatricial alopecia that affects women of African ancestry. More than one member in a family may experience the problem. In most cases, cicatricial alopecias are not transmittable. They are not linked with other illnesses either. Healthy women and men can suffer this problem. Those who suffer cicatricial alopecia do not usually have a family history of the problem or similar condition.

 

Diagnosis

 

The absence of the openings of the hair follicles is a kind of hallmark of cicatricial alopecia. In order to confirm the diagnosis, a scalp biopsy is essential. While performing a biopsy, an area affected by inflammation needs to be selected. A hair pull test is useful in finding out where to perform a biopsy. In a hair pull test, a clump of hair is pulled from the area of active disease. The number of hairs that pull out in each pull and observation on if the hair follicles contain intact follicles; form the basis for results of the pull test. Usually, five or more hairs get produced in a positive pull test. This indicates that hair follicles are getting damaged and loosened due to an active inflammation.

 

Result of biopsy or the type of inflammation found out and the overall pattern of hair loss help a doctor figure out the specific type of cicatricial alopecia present and its degree of activity. Such diagnosis helps the doctor select the most appropriate therapy.

 

In addition, other factors help a doctor with diagnosis and management. Such factors are mentioned below.

  • The rate at which hair fall progresses and the date of onset. 
  • Specific symptoms such as itching, pain and burning.
  • Medical history of any disease, infections or trauma.
  • Information on any previous treatments.
  • Family history of the patient.

 

Additionally, in case pustules are present, the doctor may try to find out if there is any microbe that may be contributing to the inflammation. In case, there are very few symptoms, scalp biopsy can still reveal active inflammation. For future comparison, it is necessary to photograph the overall extent and pattern of hair loss.

 

Specific Conditions

 

Lichen Planopilaris (LPP)

 

Lichen planopilaris (LPP) is one of the types of scarring alopecia. Mainly adult women experience this problem. Usually patients have a history of patchy hair loss and symptoms like itching, pain and burning. The progress of hair loss may be slow, in which hair thinning occurs over several years. The progression of hair loss can also occur rapidly over several months.

 

There are openings of hair follicles on the scalp, through which hair comes out. Absence of these openings of hair follicles strongly indicates that the development is because of a scarring form of hair loss rather than generic hair loss. With LPP, there may be irritation and redness around the margins of the areas of hair loss. The center of the hair loss can be one or more than one and located anywhere on the scalp. When LPP gets suspected, a scalp biopsy needs to be performed to confirm the diagnosis.

 

In order to prevent disease progression, therapy is used. Treatment is used for patients with active disease progression. Generally, medications like mycophenolate mofetil and hydroxychloroquine are effective in minimizing symptoms and signs of LPP.  

 

Frontal Fibrosing Alopecia (FFA)

 

Frontal fibrosing alopecia is another form of hair loss. It is mainly women who experience this issue. Recession of the hairline is a common complaint and linked with loss of ones eyebrows. In case of FFA, hairs are not thinned. Instead, full thickness hairs get interspersed with localized areas of balding. Typically, patients experience about one inch of recession of the frontal hairline, which is linked with irritation and redness of the scalp, especially around the hair shafts. Itching is also associated with this condition. The recession of the hair can be slow or fast.

 

Loss of eyebrows can also happen alongside hairline recession. In some cases, patients may also experience loss of eyelashes and loss of hair on their legs and arms. These are clinical signs that facilitate the diagnosis of FFA.

 

Once the diagnosis of FFA is confirmed by a biopsy, the next step is about treatment strategies. Medical management or oral medications are the first line. Doxycycline and hydroxychloroquine are among the oral medications. Topically like corticosteroids and intralesional, injection of steroids can be used. Intralesional corticosteroids can be used to deal with loss of eyebrows.

 

Central Centrifugal Cicatricial Alopecia (CCCA)

 

Usually women of African descent experience central centrifugal cicatricial alopecia (CCCA), which is a type of scarring cicatricial alopecia. Even though the cause is not known yet, genetic predisposition may play a role in certain patients. This draws a distinction between CCCA and other forms of alopecia. It is not clear if aggressive hairstyling is the cause of this condition. But, chemicals, heat and traction are suspected to play a role in CCCA.

 

Typically, the symptoms include occasional itching or tenderness. Before the symptoms get noticed, significant hair loss can occur. In the beginning, thinning may occur over a small area of the central scalp, eventually involving a larger area on the sides and top of the scalp. In the affected regions, very thin hair may remain. While examining, a physician usually checks for hair breakage. Hair breakage is a sign of fragile hair, which gets caused by trauma to the hair shaft.

 

If biopsy does not confirm an active inflammation, medical management is unlikely to be effective. When a patient experiences increased hair fall and a biopsy reveals inflammation and then both oral medications and topical therapy may be useful.

 

It is a good idea to change hair care practices, such as avoiding hair braiding, chemical perms and excessive heat. This can be helpful in slowing down progress of CCCA.

 

Treatment

 

First line oral medications include doxycycline, hydroxychloroquine, etc. Second line oral medications include cyclosporine, mycophenolate mofetil, etc. Third line oral medication includes pioglitazone. Topical medications include topical tacrolimus, corticosteroids and topical pimecrolimus or Derma-smoothe. Intra-lesional remedy includes triamcinolone acetonide, which may be injected into inflamed or symptomatic areas of the scalp.

 

Treatment usually gets continued till the signs of scalp inflammation are minimized and progress of the condition has been controlled. Treatment needs to be continued until itching, pain, burning, tenderness, scalp redness and pustules are gone and the hair fall ceases to continue. After the condition has been inactive for years, one may consider surgical treatment for cosmetic benefit.

 

Prognosis

 

Scarring cicatricial alopecias do not have negative effects on one’s general health. Once the hair follicles are destroyed, hair will not regrow. In many cases, doctors can take care of inflammation before too many hair follicles have been ruined. In order to beat the inflammatory process, it is important to begin treatment as early as possible. Typically, the affected area of the scalp can be covered by hair from the surrounding areas. Patients may use hats or wigs. It is important to consult a qualified hair specialist as soon as you start to notice symptoms of any form of hair loss including scarring cicatricial alopecia.

 

Scarring Alopecia Treatment with PRP

 

Cicatricial alopecias or scarring alopecias are a group of hair fall conditions, which involve small scars around the hair follicles. Such hair loss conditions include frontal fibrosing alopecia (FFA), lichen planopilaris (LPP), folliculitis decalvans (FD), central centrifugal alopecia (CCCA), etc.

 

Treatments are usually effective in halting the conditions. For different conditions, treatments can vary, including steroid injections and topical steroids as well as several pill forms of treatments like dutasteride, finasteride, mycophenolate mofetil, doxycycline, hydroxychloroquine, etc.

 

Refractory Scarring Alopecia

 

Traditional methods of treatment are beneficial for about 50-70% of patients. In some cases, scarring alopecia does not respond to medications in a way it is expected to. Such condition is known as refractory scarring alopecia. For patients with refractory scarring alopecia, there is a new treatment option, namely Platelet Rich Plasma (PRP).

 

Platelet Rich Plasma (PRP)

 

Platelet rich plasma (PRP) therapy involves use of platelet cells from patient’s own blood to stimulate hair growth. Platelets are a component of blood cells. They possess various growth factors and cytokines, which can potentially stimulate the hair growth. The PRP is not effective in all patients with scarring alopecia. Research suggests that PRP may cause new blood vessels to form around hair follicles in scar tissue, which may facilitate survival of hairs.

 

PRP for refractory Scarring Cicatricial Alopecias

 

A dermatologist needs to get involved to confirm that a patient has refractory scarring cicatricial alopecias and is a candidate for PRP. Below are the different types of cicatricial alopecias in relation to criteria for PRP.  

 

Lichen Planopilaris (LPP)

 

For patients with LPP, treatments other than PRP are advisable as first line of treatment. Experts recommend use of steroid injections, hydroxychloroquine and doxycycline for all patients with LPP. Hair regrowth is unlikely in most cases of scarring alopecias including LPP. Halting the hair fall is the main goal to be achieved by treatment. Even the PRP therapy can not cause hair regrowth. It may also just help slow down the progression of hair shedding.

 

Before a patient with LPP becomes a candidate for PRP, a patient is expected to meet the following criteria.

 

A dermatologist has to evaluate the condition. A dermatologist needs to follow perfllicular erythema, perifollicular scale and measurements.

  • The patient needs to use topical steroids.
  • The patient needs to use steroid injections.
  • The patient needs to use doxycycline.  
  • The patient needs to use at least one of mycophenolate mofetil pills or hydroxychloroquine pills.
  • Once a patient is done trying these treatment options, he or she can try the PRP.

 

Frontal Fibrosing Alopecia (FFA)

 

The PRP is not advisable as first line of treatment for patients with FFA. Dutasteride and finasteride are advisable to for all patients with FFA. The main goal of treating FFA is to stop progression of hair loss. Hair regrowth is usually not possible in most cases of scarring alopecias including FFA. There is only one treatment that may prompt hair regrowth. This treatment includes dutasteride and finasteride. Before a patient becomes a candidate for PRP, he or she needs to meet the following criteria.

 

A dermatologist needs to evaluate the condition. A dermatologist needs to follow perifollicular erythema, perifollicular scale and measurements.

  • The patient needs to try topical steroids.
  • The patient needs to try steroid injections.
  • The patient needs to try doxycycline.
  • The patient needs to try at least one of mycophenolate mofetil pills or hydroxychloroquine pills.
  • The patient needs to try dutasteride or finasteride, both of which have been proven to be effective in treating FFA.

 

Folliculitis Decalvans (FD)

 

PRP is not the first line of treatment for patients with FD. Hair regrowth is not possible in case of FD. Halting the progression of hair loss is the main goal in treating FD. Even PRP cannot help with hair regrowth. Before a patient becomes a candidate for PRP, he or she needs to meet the following criteria.

 

The patient needs to involve a dermatologist. A dermatologist needs to follow perifollicular erythema, scaling, crusting and pustules.

  • The patient needs to try topical antibiotics.
  • The patient needs to use antibiotic pills.
  • The patient needs to use isotretinoin.

 

As antibiotics and isotretinoin have been proven to be beneficial, they are particularly important for patients to try before going for PRP.

 

Central Centrifugal Cicatricial Alopecia (CCCA)

 

For patients with CCCA, PRP is not the first line of treatment. Neither PRP nor other treatment options can help with hair regrowth. The only goal of any treatment option is to stop progression of hair loss. Before a patient becomes a candidate for PRP, he or she needs to meet the following criteria.

 

A dermatologist needs to evaluate the condition of the patient and follow disease activity.

  • The patient needs to use topical steroids.
  • The patient needs to use steroid injections.
  • The patient needs to try doxycycline.

 

As antibiotics like doxycycline and steroid injections have been proven to be beneficial, they’re of particular importance for patients to try before going for PRP.

 

PRP may or may not be necessary, depending on how other treatment options respond and whether a dermatologist recommends PRP.

 

 

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