Cicatricial (Scarring) Alopecia: What It Is, Why Early Action Matters, and How to Live Well with It

A plain-language guide for people who have been told they may have a scarring form of hair loss, or who are trying to understand what that means.

Updated: March 2026

Types of Hair Loss

What Is Cicatricial Alopecia?

Cicatricial alopecia, also called scarring alopecia, is an umbrella term for a group of hair loss conditions that share one defining characteristic: they permanently destroy hair follicles. Where most forms of hair loss leave the follicle intact and capable of regrowth, cicatricial alopecia involves inflammation that damages the follicle beyond recovery and replaces it with scar tissue. Once a follicle is scarred, it cannot produce hair again.

This is what makes cicatricial alopecia fundamentally different from androgenetic alopecia, alopecia areata, telogen effluvium, and most other hair loss conditions covered in this series. In those conditions, the follicle remains alive and regrowth remains possible. In cicatricial alopecia, the goal of treatment is to stop the damage before more follicles are lost, not to restore what has already been destroyed.

The word “cicatricial” comes from the Latin for scar. These are serious conditions that warrant specialist medical care. If you have been told your hair loss may be scarring in nature, seeing a dermatologist who specializes in hair disorders promptly is one of the most important things you can do.

That said, there is also good news: the active inflammatory process can often be slowed or halted with appropriate treatment, and effective appearance solutions exist for the hair loss that has already occurred. Many people with cicatricial alopecia live full, confident lives with the right combination of medical care and practical support.

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What Are the Different Types?

Cicatricial alopecia is not a single condition but a family of related disorders. They are divided into two broad categories based on what causes the follicle damage.

Primary Cicatricial Alopecia

In primary cicatricial alopecia, the hair follicle itself is the target of the destructive process. The inflammation originates within or around the follicle, often due to autoimmune or inflammatory mechanisms that are not yet fully understood. Common forms include:

• Lichen planopilaris (LPP): One of the more common forms, involving inflammatory destruction of follicles. It is considered autoimmune in nature. Symptoms often include itching, burning, and scaling around affected follicles.
• Frontal fibrosing alopecia (FFA): A form of LPP that specifically affects the frontal and temple hairline, causing it to recede gradually. It most commonly affects postmenopausal women, though it can occur in anyone. FFA is increasingly recognized and is one of the more frequently diagnosed primary cicatricial alopecias today.
• Central centrifugal cicatricial alopecia (CCCA): A condition that begins at the crown and spreads outward. It is most commonly seen in women of African descent and may involve both genetic and hair care-related factors. CCCA is among the most common forms of permanent hair loss in Black women and deserves much greater awareness than it currently receives.
• Folliculitis decalvans: Folliculitis decalvans is characterized by recurring inflammation and pustules around follicles, often associated with a bacterial component. It can cause progressive patchy hair loss with scarring.
• Dissecting cellulitis: A chronic inflammatory condition producing nodules, sinus tracts, and scarring, most commonly seen on the scalp of young men.
• Discoid lupus erythematosus (DLE): A skin manifestation of lupus that, when it affects the scalp, can cause permanent hair loss with distinctive redness and scarring.

Other, rarer primary cicatricial alopecias exist. A dermatologist with experience in hair disorders can identify the specific type through a combination of clinical examination and scalp biopsy.

Secondary Cicatricial Alopecia

Secondary cicatricial alopecia occurs when the follicle is destroyed as a consequence of something else, rather than being the primary target of the inflammatory process. Common causes include severe burns (thermal or chemical), radiation treatment for cancer, physical trauma, severe infections, and certain skin cancers or tumors. In these cases, the hair loss is a result of broader tissue damage.

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Why Does Early Diagnosis Matter So Much?

This point deserves emphasis: in cicatricial alopecia, time matters in a way that is not true for most other hair loss conditions. Because the follicles that are destroyed cannot recover, every month of active, untreated inflammation means additional permanent loss. The earlier treatment begins, the more follicles can be preserved.

This is one of the most important messages on this page. If you have scalp symptoms, particularly persistent itching, burning, tenderness, or redness around hair follicles, combined with progressive hair loss, please see a dermatologist promptly. Do not wait to see whether it resolves on its own. If it is cicatricial alopecia, waiting has real and irreversible consequences.

Early cicatricial alopecia can be subtle and easy to miss or misattribute to other causes. This is another reason why a dermatologist who specializes in hair disorders is the right person to evaluate any hair loss that does not have an obvious explanation.

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What Does It Look Like?

The specific appearance of cicatricial alopecia varies by type, but some features are characteristic of the broader group:

• Hair loss that does not regrow: Areas of hair loss that are stable or progressive but show no new growth, even after months.
• Smooth scalp surface: A defining feature of scarring alopecia is the absence of visible follicle openings (the tiny pores from which hairs emerge) in affected areas. The scalp looks smooth and closed, unlike androgenetic alopecia where follicles are still present but miniaturized.
• Scalp symptoms: Many people with active primary cicatricial alopecia report itching, burning, tenderness, or pain in and around affected areas. Some types produce redness, scaling, or pustules.
• Progressive spread: Active cicatricial alopecia typically expands over time. The rate of progression varies considerably between individuals and between types.
• Pigmentation changes: The affected scalp may be lighter or darker than surrounding skin.

Not all types produce obvious scalp symptoms, which is part of why regular monitoring by a specialist matters even when the condition seems quiet.

Important: Scarring alopecia can look similar to other conditions in early stages. Only a dermatologist with experience in hair disorders, using scalp examination and often a scalp biopsy, can make a definitive diagnosis. Do not self-diagnose based on this description.

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Getting a Diagnosis

A dermatologist who specializes in hair disorders is the right starting point. General dermatologists vary in their familiarity with the rarer forms of cicatricial alopecia, and if your diagnosis is uncertain, seeking a second opinion from a hair specialist or an academic medical center with a dedicated hair clinic is entirely reasonable and often advisable.

The diagnostic process typically involves:

• Medical and family history: Including when symptoms began, how quickly hair loss has progressed, any associated symptoms, prior diagnoses, and medications.
• Clinical examination: Close examination of the scalp, including dermoscopy (trichoscopy), which uses a magnifying instrument to visualize follicle openings, inflammation patterns, and scalp characteristics that help distinguish between types of alopecia.
• Scalp biopsy: In most cases of suspected cicatricial alopecia, a small sample of scalp tissue is taken and examined under a microscope. This is the gold standard for confirming the diagnosis and identifying the specific type. It is a minor procedure performed under local anesthetic.
• Blood tests: May be recommended to look for associated conditions, particularly in forms linked to autoimmune or systemic disease.

Receiving a cicatricial alopecia diagnosis can feel frightening, particularly when the word “permanent” is involved. Having a clear, confirmed diagnosis, however difficult, is the essential first step toward a plan that makes the most of the follicles you have and addresses the hair loss that has occurred.

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What Treatment Options Exist?

There is currently no cure for primary cicatricial alopecia. However, treatment can slow or halt the inflammatory process in many cases, preserving the hair follicles that remain. All treatment decisions should be made in consultation with a dermatologist experienced in scarring alopecia. The right approach depends on the specific type, the degree of activity, the rate of progression, and individual health factors.

Stopping the Inflammation

The primary goal of medical treatment is to reduce or eliminate the inflammation that is destroying follicles. Depending on the specific type and severity, a dermatologist may discuss a range of prescription anti-inflammatory and immune-modulating treatments. Some are applied topically or injected directly into the scalp. Others are taken orally. Some forms of cicatricial alopecia have a bacterial component that is addressed alongside the inflammation.

The treatment landscape for cicatricial alopecia has been evolving, with newer classes of medications showing promise in forms that did not respond well to older approaches. A specialist who follows this field actively will have the most current perspective on what options are appropriate for your specific type.

Monitoring and Regular Follow-Up

Even when the condition appears stable, regular follow-up with a specialist is important. Cicatricial alopecia can become active again after periods of apparent inactivity, and ongoing monitoring allows for prompt response if that occurs.

Hair Transplantation

In cases where the active inflammatory process has been fully stable for a sustained period, typically at least one to two years without new activity, hair transplantation may be considered for some forms of cicatricial alopecia to improve the cosmetic appearance of affected areas. This is a specialized decision that requires both a dermatologist confirming the condition is inactive and a hair restoration surgeon experienced in transplanting into scarred tissue. Not all types and not all patients are good candidates. A specialist can advise whether this is an option worth exploring in an individual case.

Gentle Hair Care

For forms of cicatricial alopecia where hair care practices may be contributing, particularly CCCA, gentle care practices are an important part of management. This means avoiding tight hairstyles, heat styling, and chemical treatments that put stress on follicles that are already under inflammatory pressure. A dermatologist can advise on specific practices relevant to your type.

For specialist referrals and up-to-date information: The Scarring Alopecia Foundation at scarringalopecia.org provides patient resources, information on specific types, and guidance on finding specialist care. The American Academy of Dermatology at aad.org also offers reliable patient information on hair loss diagnosis.

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Managing Your Appearance

Regardless of what the medical treatment picture looks like, having practical appearance solutions in place is entirely appropriate and can make an enormous difference to daily wellbeing and confidence. The hair loss that has already occurred will not return, and there is no reason to wait or feel that a hair solution is premature or conditional on other things being resolved first.

Transitions International member studios work regularly with people who have cicatricial alopecia and understand the specific considerations involved, including the need for solutions that work with a scalp that may have areas of sensitivity or changed texture.

Custom Non-Surgical Hair Systems

For those with significant or widespread hair loss, a custom hair system provides full, natural-looking coverage. Modern systems use premium human hair on ultra-thin, breathable bases that sit gently against the scalp without tension or irritation. They are individually crafted to match your natural hair color, texture, and style, and allow for normal daily activity. For people whose cicatricial alopecia has progressed significantly, a custom system often restores a sense of normalcy and confidence that is difficult to overstate.

Partial Toppers and Integration Systems

For those with more localized areas of loss, a hair topper or integration system can blend with existing hair to provide coverage where it is needed without a full replacement system. This is a practical and comfortable option for people whose loss is concentrated in one area, such as the frontal hairline in frontal fibrosing alopecia or the crown in CCCA.

Scalp Micropigmentation

For those who prefer a closely shaved or cropped aesthetic, scalp micropigmentation uses specialized cosmetic tattooing to create the appearance of hair follicles across the scalp. It is permanent, low-maintenance, and well-suited to people who want a consistent, confident look without ongoing maintenance of a hair system.

Scalp Sensitivity Considerations

Some forms of active cicatricial alopecia involve scalp tenderness or sensitivity. A Transitions member studio experienced with these conditions can advise on the most appropriate attachment methods and materials for your specific situation. It is always a good idea to let the studio know about your diagnosis so they can make informed recommendations about what will be most comfortable and appropriate.

Find a Transitions member specialist near you.

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The Emotional Side

Cicatricial alopecia carries particular emotional weight, because the permanence of the hair loss adds a dimension that many other conditions do not have. For people who have received a diagnosis, there is often grief, not only for the hair that has been lost, but for the uncertainty about how much more may be lost before the condition stabilizes.

That grief is valid. So is the anxiety about what comes next. These are understandable responses to a genuinely difficult situation.

A few things that many people find helpful:

• Getting clear information. Understanding your specific type, its typical behavior, and what treatment is doing gives a sense of agency in a situation that can otherwise feel completely out of control.
• Having a practical solution in place. Many people find that the relief of having an appearance solution that works well significantly reduces the daily emotional burden. You do not have to live with the visible evidence of the loss while everything else is being sorted out.
• Connecting with others who understand. The Scarring Alopecia Foundation at scarringalopecia.org provides community connections and resources for people navigating these conditions.
• Professional support. A counselor or therapist familiar with chronic conditions or appearance-related concerns can provide real tools for managing the emotional dimensions of a diagnosis like this.

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Finding Help

• See a dermatologist who specializes in hair disorders as soon as possible if you suspect cicatricial alopecia or have been told your hair loss may be scarring in nature. Time matters with these conditions in a way it does not with most others. Ask your primary care provider for a referral or contact an academic medical center with a hair disorders clinic.
• Visit the Scarring Alopecia Foundation at scarringalopecia.org for condition-specific information, specialist referral guidance, and community resources.
• Visit the American Academy of Dermatology at aad.org for general patient information on hair loss diagnosis and evaluation.
• Connect with a Transitions member studio to explore appearance solutions. Our member studios are experienced with the full range of hair loss conditions, including cicatricial alopecia, and can advise on the most appropriate solutions for your specific situation and scalp needs. Find a member near you.

References

1. Scarring Alopecia Foundation. Types of Scarring Alopecia. scarringalopecia.org
2. Harries MJ, Sinclair RD, Macdonald-Hull S, Whiting DA, Griffiths CE, Paus R. (2009). Management of primary cicatricial alopecias: options and future prospects. Br J Dermatol. 160(1):1-22. PubMed 19067685
3. Olsen EA, et al. (2003). Summary of North American Hair Research Society (NAHRS)-sponsored workshop on cicatricial alopecia. J Am Acad Dermatol. 48(1):103-110. PubMed 12522378
4. Otberg N, Shapiro J. (2012). Cicatricial (Scarring) Alopecias. In: Wolff K, et al. Fitzpatrick’s Dermatology in General Medicine. 8th ed. McGraw-Hill.
5. Aguh C, Oluwole T. (2021). Central Centrifugal Cicatricial Alopecia. StatPearls. StatPearls Publishing. ncbi.nlm.nih.gov/books/NBK559198
6. American Academy of Dermatology Association. Hair loss: Diagnosis and treatment. aad.org
7. Farrell AM, et al. (2023). Off-label use of biologics and JAK inhibitors for scarring alopecias: A comprehensive review. PMC12148979

Medical Disclaimer

Transitions International Group is a professional membership association representing hair restoration studios and specialists. We are not a medical practice, and nothing on this website constitutes medical advice, a clinical diagnosis, or a treatment recommendation of any kind.

The information on this page is provided for general educational purposes only. Cicatricial alopecia encompasses a group of serious medical conditions requiring diagnosis and treatment by qualified healthcare professionals, typically a dermatologist specializing in hair disorders. Do not use this page to self-diagnose or self-treat. Do not delay seeking professional medical care based on anything you have read here.

Results of any solution or approach described on this website vary by individual.

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