Early Symptoms and Diagnosis of Scarring Alopecia: What to Watch For

Hair loss is a common concern, but not all hair loss is created equal. While many forms of alopecia are temporary and treatable, scarring alopecia (also known as cicatricial alopecia) is a more serious condition. It can lead to permanent hair loss due to the destruction of hair follicles. Therefore, early detection and diagnosis are crucial to minimize hair loss and prevent further damage.

But what exactly should you look for? In this blog we’ll provide you with a detailed overview of early symptoms of scarring alopecia, the diagnostic process, and why prompt medical attention is important in addressing scarring alopecia.

The Insidious Nature of Scarring Alopecia: Why Early Detection Matters

Unlike common hair loss conditions such as androgenetic alopecia (pattern baldness) or telogen effluvium, scarring alopecia involves inflammation of the hair follicles that ultimately destroys it and replaces it with scar tissue. Once a hair follicle is scarred, it cannot grow hair again. This is why early intervention is important. The sooner the inflammation is controlled, the more hair follicles can be saved, preserving your hair and scalp health.

Early Symptoms: More Than Just Shedding

While increased hair shedding can be a prominent symptom of many hair loss conditions, scarring alopecia often presents with more specific and sometimes subtle signs. So, it’s important to pay close attention to the following:

1. Scalp Symptoms: Itching, Burning, and Pain

This is often one of the earliest and most distressing indicators. Many individuals with scarring alopecia experience:

• Persistent Itching (Pruritus): This isn’t just a mild itch. It can be intense, persistent, and localized to specific areas of the scalp.
• Burning Sensation: A feeling of heat or burning on the scalp, even without touching it.
• Pain or Tenderness: The affected areas of the scalp may feel sore, tender to the touch, or even painful. This pain can range from a dull ache to sharp, shooting sensations.
• Tingling or Paresthesia: Some people also report unusual tingling or crawling sensations on the scalp.

2. Redness and Inflammation of the Scalp

Visually, you might notice the following signs of scarring alopecia:

• Erythema: Red or pink colored patches on the scalp in localized areas.
• Follicular Inflammation: The skin around hair follicles may appear red and swollen, looking like small pimples or bumps. These can be particularly noticeable at the base of the hair shaft.
• Scaling: Flaking or scaling of the scalp, similar to dandruff but often more tenacious and localized.

3. Unusual Hair Loss Patterns

While hair loss can be diffuse, scarring alopecia often presents with characteristic patterns:

• Patchy Hair Loss: The hair loss may occur in distinct, irregular patches. These patches may gradually enlarge over time.
• Absence of Follicular Openings: This is a key visual clue for dermatologists. In areas of active scarring, you might notice a complete absence of the tiny pores (follicular openings) where hair usually emerges. The scalp in these areas may appear smooth and shiny.
• “Tufting” or “Doll’s Hair” Appearance: In some forms of scarring alopecia, such as folliculitis decalvans, multiple hair shafts may emerge from a single follicular opening, giving a “tufted” appearance.
• Changes in Hair Texture: The remaining hair around the affected areas, especially at crown (CCCA) or hairline (FFA), might become brittle, dull, or break easily.

4. Pustules or Sores (in certain types)

• Folliculitis Decalvans: This type of scarring alopecia is characterized by recurrent pustules (pus-filled bumps) on the scalp, leading to scarring and permanent hair loss.
• Dissecting Cellulitis of the Scalp: This presents painful, boggy nodules, abscesses, and sinus tracts that drain pus. This can lead to extensive scarring and permanent hair loss.

The Diagnostic Journey: What to Expect at the Doctor’s Office

If you notice the above symptoms, it’s important to see a dermatologist who specializes in hair and scalp conditions. Here’s the diagnostic criteria that they will use for scarring alopecia diagnoses:

Detailed Medical History

Your dermatologist will ask you a series of questions about:

• Symptom Onset & Nature: When symptoms (hair loss, itching, pain, burning) began and how they feel.
• Hair Loss Progression: How quickly the hair loss is worsening.
• Associated Symptoms: Any other body symptoms (fatigue, joint pain, rashes).
• Family & Medical History: Family history of hair loss/autoimmune conditions, current medications, and existing health conditions.

Scalp Examination

Your dermatologist will closely examine your scalp using a specialized tool called dermoscope. They will look for:

• Signs of inflammation such as redness, scaling, and pustules.
• Presence or absence of follicular openings.
• Hair shaft abnormalities.
• Characteristic patterns of hair loss.
• Scarring of hair follicles.

Hair Pull Test

It is a quick, non-invasive diagnostic test used by dermatologists to assess the severity and type of hair loss. It involves gently pulling on a bundle of hair to check how easily hair comes out and whether the hair loss is active.

Scalp Biopsy (The Gold Standard)

This is the most definitive diagnostic tool for scarring alopecia. A small sample of tissue (usually 4mm in diameter) is taken from an active area of hair loss and sent to a pathology lab for microscopic examination. The biopsy helps to determine the following;

• Specific type of inflammatory cells attacking the hair follicles.
• Severity of inflammation.
• Extent of follicular destruction and scarring.

Blood Tests

Sometimes direct diagnostic criteria isn’t enough to rule out scarring alopecia. Therefore, in such cases different blood tests are ordered which are as follows:

• Thyroid levels
• Vitamin D, iron, and ferritin levels
• ANA test

These may help to rule out other causes. For example; thyroid disorders, nutritional deficiencies, or autoimmune conditions.

Enroll in Clinical Trials

Another diagnostic tool for understanding scarring alopecia is enrolling in ongoing clinical trials at MBCP. It helps to understand and manage the condition effectively.

Why Timely Diagnosis is Critical

Scarring alopecia is a progressive condition, meaning it gets worse over time. But here’s the good news: If caught early, doctors can often stop or slow the damage and help save the remaining hair.

However, if diagnosis and treatment of scarring alopecia is delayed, it can have significant consequences which are as follows:

• Irreversible Hair Loss: The more inflammation persists, the more hair follicles are permanently destroyed.
• Increased Scarring: Extensive scarring can make future hair restoration options (like hair transplantation) more challenging or impossible.
• Psychological Impact: Living with progressive and visible hair loss can lead to significant emotional distress, anxiety, and depression.
• Systemic Implications: In some cases, scarring alopecia can be a manifestation of a broader systemic disease, for example; an autoimmune disorder, which requires timely medical management.

Conclusion: Don’t Delay, See a Dermatologist

Scarring alopecia is a challenging condition, but early recognition of its symptoms and accurate diagnosis can prevent permanent damage. So, if you notice persistent scalp itching, burning, pain, redness, or any unusual patterns of hair loss, do not hesitate to schedule an appointment with a dermatologist.

In conclusion, early interventions can make a profound difference in subsequently preserving your hair and managing your symptoms. Remember, your scalp’s health is just as important as the rest of your body. So, give it the attention it deserves.