What causes scarring alopecia?

In most types of scarring alopecia, there’s inflammation around the middle (bulge) of your hair follicle. This part of your follicle contains stem cells and oil glands, which are both needed for new hair growth. Inflammation destroys this part of the follicle and causes scar tissue to grow (fibrosis), so hair can’t regenerate.

The follicular ostia (openings in your skin where hair follicles reside) are usually closed in people with scarring alopecia.

In nonscarring alopecia, there’s usually damage to the base (bulb) of your hair follicle, not the bulge. That’s why hair can often regrow if you have nonscarring alopecia.

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You may know that chemotherapy can cause hair loss. But chemotherapy doesn’t lead to scarring alopecia. Chemotherapy drugs can cause cells in your hair follicle to die, so your hair falls out. But the follicle itself isn’t destroyed, so hair can usually grow back after chemotherapy.

Radiation therapy, on the other hand, can lead to secondary scarring alopecia. Some people get skin burns from radiation therapy that permanently destroy hair follicles.

Hair loss is the main symptom of cicatricial alopecia. It usually causes focal hair loss, meaning you lose hair in patches. Hair loss might start slowly and happen gradually over many years. Or it can start suddenly and progress quickly.

Scarring alopecia tends to affect the scalp, but it can happen anywhere you have hair.

In addition to hair loss, some people experience skin problems, such as:

Bleeding.

Blistering.

Burning.

Crusting or scaling.

Itching, tingling or tenderness.

Pustules.

Redness or other discoloration.