From the Guidelines
Cicatricial alopecia and non-cicatricial alopecia differ significantly in their pathogenesis, clinical presentation, and treatment, with cicatricial alopecia involving permanent destruction of hair follicles and non-cicatricial alopecia preserving the potential for hair regrowth. The pathogenesis of cicatricial alopecia involves inflammatory processes that destroy the hair follicle stem cells, leading to irreversible hair loss, whereas non-cicatricial alopecia, such as alopecia areata, preserves the hair follicles and allows for potential regrowth 1.
Clinical Presentation
Clinically, cicatricial alopecia presents with areas of permanent hair loss, smooth skin, and loss of follicular openings, while non-cicatricial alopecia may present with patchy hair loss, and the potential for spontaneous remission, as seen in alopecia areata, where up to 80% of patients with limited patchy hair loss of short duration may experience spontaneous remission 1.
Treatment
Treatment for cicatricial alopecia focuses on halting disease progression and managing symptoms, and may include topical or intralesional corticosteroids, oral anti-inflammatories, or immunosuppressants, whereas non-cicatricial alopecia may be managed with topical corticosteroids, such as clobetasol propionate, which has shown some effectiveness in promoting hair regrowth 1.
- Key differences in treatment approach:
- Cicatricial alopecia: aim to halt progression and manage symptoms
- Non-cicatricial alopecia: aim to promote hair regrowth and manage symptoms
- Important considerations:
- Early diagnosis and treatment are crucial in preserving remaining hair follicles in cicatricial alopecia
- Spontaneous remission is a potential outcome in non-cicatricial alopecia, such as alopecia areata, and may be a viable management option for some patients 1
From the Research
Pathogenesis
- Cicatricial (scarring) alopecia is characterized by the destruction of the hair follicle unit, which is replaced by fibrous tissue 2
- The pathogenesis of cicatricial alopecia involves an unknown inflammatory mechanism that destroys the hair follicle 3
- In contrast, non-cicatricial (non-scarring) alopecia does not involve the destruction of the hair follicle unit
Clinical Presentation
- Cicatricial alopecia is characterized by permanent hair loss, with visible changes in skin surface morphology and the replacement of follicular structures with scar-like fibrous tissue 4
- Non-cicatricial alopecia, on the other hand, may present with reversible hair loss
- Patients with cicatricial alopecia may experience symptoms such as scalp itching, burning, or tenderness 5
Treatment
- The aim of treatment for cicatricial alopecia is to slow or stop the progression of the inflammatory waves and the scarring process 2
- Treatment options for cicatricial alopecia include reducing symptoms and preventing disease progression and further hair loss 5
- In contrast, treatment for non-cicatricial alopecia may focus on promoting hair regrowth and addressing underlying causes of hair loss
- Early treatment is key to minimizing the extent of permanent alopecia in cicatricial alopecia 4, 6