Hair loss or alopecia is a common complaint in any dermatology practice. When dermatologists evaluate patients for hair loss, it is important to distinguish clinically whether the alopecia is either scarring or non-scarring. The approach to the patient and the treatment options will be impacted by the differences.
Scarring alopecia is most often caused by either infection or inflammatory reasons. Infectious causes include conditions such as cellulitis of the scalp which results in strong inflammatory changes that lead to chronic scarring. Inflammatory diseases such as lichen planus of the scalp (lichen planopilaris) or discoid lupus often result in chronic scarring of the scalp which destroys the follicles and results in alopecia. Scarring alopecia unfortunately has a poorer prognosis for regrowth and efforts to treat these causative conditions at early stages are the focus to provide patients with hope for a better outcome.
Non-scarring alopecias include both male and female alopecia which tend to be hereditary as well as hormonal; hair loss caused by medication as seen with chemotherapy; autoimmune-induced such as alopecia areata; and stress-induced hair loss often termed telogen effluvium. Many non scarring alopecias are reversible with simple changes such as discontinuation of a causative medication or stress avoidance. But there are now available effective treatments both topical and systemic, as well as procedures such as platelet-rich plasma injections and hair transplantation which can aid when more conventional treatments have stalled. With more treatment options available, the future of reversible hair loss is constantly advancing.