Cicatricial Alopecia (Scarring Alopecia) Post Series: Three
07 / 14 / 16

Cicatricial Alopecia (Scarring Alopecia) Post Series: Three

How is it diagnosed?

This third blog post in a series on cicatricial alopecia continues with new learnings regarding associations with other illnesses, diagnosis, and seeking treatment. Much of the information provided is from the Cicatricial Alopecia Research Foundation or CARF. Their website is, and I encourage everyone seeking more in-depth knowledge to visit the site.

If you’re just now reading up on scarring alopecia, previously four questions have been answered:

  1. What is cicatricial alopecia or scarring alopecia?
  2. Are there different kinds of cicatricial alopecia?
  3. What causes cicatricial alopecia?
  4. Who is affected by cicatricial alopecia?

With these four topics addressed, we move on, bringing to light more analyses.

Are cicatricial alopecias associated with other illnesses?

Adding to the confusion swirling around scarring alopecia, according to CARF, in general, cicatricial alopecias are not connected to other illnesses, and surprisingly usually occur in healthy men and women. Patients with chronic cutaneous lupus erythematosus may have an increased personal and family history of autoimmune disorders.

How are cicatricial alopecias diagnosed and how do I seek treatment?

To determine if, in fact, cicatricial alopecia is to blame for your hair loss, the Cicatricial Alopecia Research Foundation states a possible scalp evaluation is necessary, but an essential first step towards diagnoses is a scalp biopsy.

Clinical Scalp Evaluation

Even though not always visible, there are cases where several symptoms or signs are evident; therefore clinical evaluations of the scalp, conducted during a consultation, are also necessary. These symptoms include itching, burning, pain or tenderness that usually signals ongoing activity. Signs of scalp inflammation include redness, scaling, and pustules. If pustules are present, cultures may be performed to identify which microbes, if any may be contributing to the inflammation. Also, during the consultation scalp evaluation, the overall extent and pattern of hair loss is noted and I often take photographs for future comparison.

Scalp Biopsy

Remember that we know inflammation targeted towards the hair follicle causes this disorder, so we look at scalp biopsy findings to determine the type of inflammation present, the location, the amount of inflammation, and other changes in the scalp.

Let’s talk a minute about the importance of having a scalp biopsy and the procedure itself. Throughout this blog series on scarring alopecia, I have explained how one factor after another can add to the pile of confusion surrounding this "series of disorders." Myself as a doctor, cannot adequately help you, as a patient, unless I am treating the problem, and a biopsy provides a definitive diagnosis as to what exactly the problem is.

However, crucial elements of a biopsy can vary, which means not all biopsies universally yield the same results. Some patients arrive at their consultation with reports in hand from a previous biopsy performed elsewhere. Confusion can set in if those reports fail to present information I need to form a treatment plan.

First, the biopsy location is very significant. Tissue samples must be taken from the infected area on your scalp. A biopsy taken from a "healthy" spot will not produce the same testing results as a biopsy from the infected area. I take a 4mm tissue sample from two different places on the scalp for testing.

Second, the pathology office analyzing the tissue samples plays a key role as well. I send all of my patient's tissue samples to a pathologist who specializes in hair and scalp disorders. This pathologist processes one sample longitudinally, and the other sample on the short axis. Examining two biopsy samples from different perspectives enables him to define a distinct cause of hair loss, and accurately communicate your results. Based on these conclusions, we can diagnose the type of cicatricial alopecia, determine the degree of activity, and choose the appropriate therapy.

Considering this disorder is not consistent across the board, essentially only a scalp biopsy confirms the active inflammation. So, as you can see, diagnosing and treatment of cicatricial alopecias can be challenging due to inconsistencies of the disorders. For this reason, it is crucial to have an evaluation by a doctor who specializes in scalp and hair disorders, as well as familiar with current diagnostic methods and therapies. I am happy to discuss all of this in detail during a consultation and answer any questions.