Is destruction of the oil glands a key step in the development of scarring alopecia?

Scarring Scarring Alopecia: Oil gland destruction may be a key early stepalopecias are a group of hair loss conditions that lead to permanent  hair loss. An example of a scarring alopecia is shown in the photos. Although we know how to recognize these conditions, and we understand how to treat them, we understand very little about their cause.

For years it has be thought that abnormalities developing in the sebaceous glands or "oil glands" of the hair follicle can lead to scarring alopecias.  Dr Stephen Lyle and colleages at the University of Massachusetts Medical School set out to determine if the oil glands are affected in patients with various types of scarring alopecias.

Al-Zaid T et al. Sebaceous gland loss and inflammation in scarring alopecia: A potential role in pathogenesis. Journal of the American Academy of Dermatology 2011; 65: 597-603

The researchers showed that scarring alopecias frequently showed loss of the sebaceous gland. For example, a reduction in sebaceous glands was seen in:

84 % of biopsy specimens from patients with the scarring alopecia lichen planopilaris

77% of biopsy specimens from patients with central centrifugal cicatricial alopecia

100 % of biopsy specimens from patients with follicultis decalvans

In many cases, the sebecaous glands were not only reduced but inflamed as well. For example, inflammation occurring in the sebaceous glands was seen in:

55 % of biopsy specimens from patients with lichen planopilaris

25 % of biopsy specimens from patients with central centrifugal cicatricial alopecia

50 % of biopsy specimens from patients with folliculitis decalvans

Conclusion: These data give further support to the current thinking that inflammation affects the sebaceous gland may be one of the "earliest steps" in the development of scaring alopecia.