Scarring alopecia, also known as cicatricial alopecia is a disease which is characterized by hair follicle disorder and destruction, which is replaced by scarred tissue. Scars which are the result of serious injuries, infections, burns, radiodermatitis, chemical damages or surgical procedures (facelift, eyebrow lift, neurosurgical procedures, skin tumor operations) have different origin (etiology) than scarring alopecia. Even though the cause of the diseases is unknown, it is believed that autoimmune process in hair follicle cells and sebaceous glands disables hair regrowth. The disease is not contagious or hereditary, and occurs at healthy individuals, regardless of their age. In majority of cases the disease appears on small areas which may gradually increase with or without accompanying symptoms, such as redness, flaking, strong itching, even pain. If the process is active, the presence of these symptoms is inevitable, as the inflammation is intensive. Diagnosis is set up after detailed analysis of case history which focuses on the way the hair is falling out and accompanying symptoms, dermoscopy which determines if the process is active and biopsy. The treatment should be initiated as soon as possible in order to reduce the symptoms and prevent major hair loss.

Scarring alopecia is divided into three groups, depending on the type of predominant inflammatory cells:

- Lymphocyte predominant: Lichen planopilaris, Frontal fibrosing alopecia, Central centrifugal cicatricial
alopecia, Pseudopelade brocq
- Neutrophilic predominance: Folliculitis decalvans, Tufted hair follicles
- Mixed cells: Acne keloidalis, Acne necrotica

Frontal fibrosing alopecia is lymphocyte form of cictricial alopecia and it is usually manifested as permanent hair loss and creation of scarring tissue in frontal part. It usually occurs at women in postmenopausal period (women older than 50). The disease is characterized by symmetrical hair loss in frontal and frontal-temporal area of the scalp, accompanied by the loss of eyebrows and eye lashes. The skin looks normal and pale. Even though the cause of the disease is not known, it is believed that it is connected with immune response and hormone component (menopause) of pathophysiology of this condition. Diagnosis is set up based on clinical presentation and observation of hair loss pattern. It is very important to make a difference between frontal fibrosing alopecia and traction alopecia which has completely different etiology and which is manifested by hair loss caused by strong traction that occurs due to long-term wearing of pony tail, buns, etc. In case of a dilemma, dermoscopy examination is mandatory, sometimes even biopsy. Efficient therapy has not been discovered yet, but we frequently use corticosteroids (topical, intradermal or oral). In case of expressed inflammation, antibiotics are to be included in the treatment. 5-alpha-reductase inhibitors, such as Finasteride, have shown good results in further prevention of hair loss.

Lichen planopilaris is a rare inflammation condition which causes uneven, but permanent hair loss. It frequently occurs at women between the ages of 40 and 60. The symptoms of the disease are part of clinical presentation of Lichen planus, and thus may affect other skin, mucous part and nails. The cause is unknown, but the disease is connected with allergy reaction to specific chemicals, virus infection, medication and even a stressful event. Typical manifestation is smooth hairless area which is reddish on the edges. There are usually several hairless areas which come close to each other, thus creating a large area of irregular form, usually at the top of the head. Usually, there are no symptoms, but sometimes itching, pain and feeling of hardness may occur. The disease often affects afro population. In only 8% of cases, the disease may occur after hair transplantation. Diagnosis is set up by clinical examination, dermoscopy and biopsy. Treatment should be initiated as soon as possible as the process is progressive and should be limited rapidly.
First of all, scarring alopecia requires proper diagnostics which will eliminate the presence of other types of non-scarring alopecia. Alopecia androgenetica can sometimes look like a mild form of scarring alopecia, but an experienced expert will make a clear distinction. Dermoscopy, as key diagnostic aid, is of crucial importance for making a diagnosis of these diseases. Even though all typed of alopecia are complicated to treat, it is important to report to the doctor as soon as possible. Experiences doctors shall put the process under control and prevent further hair loss.

 

oziljna alopecija

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