Types and Causes of Permanent Hair Loss

• Cicatricial vs. Areata Alopecia
• Immune System Involvement
• Secondary Cicatricial Alopecia
• Is Treatment for Permanent Hair Loss Possible?

Cicatricial alopecia is often a permanent type of hair loss because the hair follicles are damaged. Specifically, the stem cells that give the follicle its ability to regenerate are destroyed.⁽²⁴⁾

Although cicatricial alopecia is considered the scarring form of hair loss, this does not refer to visible scars on the scalp. Rather, it is called scarring hair loss because of the scar tissue that replaces the normal hair follicle cells beneath the surface.⁽²⁴⁾

What's the Difference Between Cicatricial Alopecia and Areata Alopecia?

Cicatricial hair loss can look like alopecia areata. However, close examination will show that with cicatricial hair loss the scalp is smooth, without any follicle openings.^{(2, 24, 180)}

Both are autoimmune disorders that attack the hair follicle. So why do cicatricial alopecias result in mostly permanent hair loss while alopecia areata does not?^(124, 125)

At least part of the answer lays in the area of the hair follicle the immune system targets:^(124, 125)

• The targets involved in alopecia areata originate in cells located in the dermal papilla, matrix, and external hair follicle sheath.
• In cicatricial alopecia, the immune system targets and destroys the permanent region of the hair follicle. This area is located in the bulge above the hair bulb in the follicle. It contains the stem cells necessary to regenerate the hair follicle and grow new hair.

Permanent Hair Loss and the Immune System

The different types of primary cicatricial alopecia are rare inflammatory scalp disorders. Hair follicles, normally immune-privileged and not affected by the immune system, are instead targeted by immune system cells.^{(13, 124, 125)}

These inflammatory immune system cells are meant to protect the body against foreign substances (such as viruses and bacteria). In primary cicatricial alopecia they turn against the body's own follicle cells, destroying and replacing them with scar tissue. This suggests that the different types of cicatricial hair loss are essentially autoimmune disorders.^{(13, 124, 125)}

In fact, primary cicatricial alopecias are categorized by the type of immune cell that targets, infiltrates, and destroys the hair follicle in each condition:^(24, 181)

What Is Secondary Cicatricial Alopecia?

Secondary cicatricial alopecia is caused by conditions (and their treatment), diseases, or trauma that may permanently damage and destroy the hair follicle. These include:⁽²⁴⁾

• Cancer
• Infections (bacterial, fungal, and viral)
• Inflammatory auto immune diseases (such as scleroderma)
• Physical trauma (such as radiation and burns)

Can Cicatricial Alopecia Be Treated?

Cicatricial alopecia can be treated to stop it from progressing and to relieve symptoms. Given the importance of hair to our self-confidence and psychological well-being, it is critical to understand the cosmetic options available to those men and women suffering from cicatricial alopecia.⁽²⁴⁾

These include an array of products and hair styles to make the hair they do have appear thicker or wigs and hairpieces. It is even possible to replace lost hair surgically in some cases.⁽²⁴⁾