posted by Sheldon S. Kabaker, MD, FISHRS on May 19, 2014
Baldness (alopecia) secondary to certain dermatologic diseases or scalp injury and subsequent scarring is called cicatricial or scarring alopecia. In medical terminology a scar is called a cicatrix.
The common causes of scarring alopecia are injury to the scalp caused by trauma, thermal burns, chemical burns, birth defects, radiation therapy, infections, electrical burns, and diseases that destroy hair follicles and scalp tissue. Scarring alopecia may involve the complete scalp or portions of the scalp. The extent of scarring, available donor hair and the patient’s wishes guide the selection of hair restoration procedures.
Nonsurgical Hair Restoration
Hair pieces, hair weaves and hair extensions can be effective nonsurgical treatments for cicatricial alopecia. But they can also lead to further hair loss. Of course, creative hairstyles, caps, hats, scarves and other types of headgear can be used to disguise scarred bald areas. Hair restoration drugs are ineffective or minimally effective to restore hair growth in scarred scalp tissue.
Surgical Hair Restoration
If cicatricial alopecia is partial, a hair-bearing portion of scalp may be available as a donor site for a hair restoration surgery. Procedures that may be considered include free or local scalp flaps with or without prior tissue expansion, and transplantation of follicular unit grafts taken from the scalp. FUE ( individually punched out hair groupings) grafts taken from the beard or body could be used to supplement scalp hair transplants. Multiple surgical sessions may be required if cicatricial alopecia is extensive and/or scarring is severe.
Dermatologic diseases causing scarring alopecia should be evaluated carefully by an expert. During the active stages of these diseases, treatment with surgery is not indicated as the transplanted hair will be affected by the same process that caused the original hair loss. Patients with these conditions can be candidates for surgery after the disease is “burned out” or no longer active.