Burnt out Inactive Scarring Alopecia: What is it?

Burnt Out Inactive Cicatricial Alopecia: What really is it?

There is a great deal of confusion and misconceptions surrounding the concept of completely “burnt out” scarring alopecia and a scarring alopecia that is “inactive” due to the treatment that is being given. How do we tell how likely a scarring alopecia is to be burnt out?

In our clinic, the likelihood of a scarring alopecia being actually “burnt out”depends on patient answers to 14 questions.

Group A Question

1. Did you use any topical, injection or oral medications over the last 2 years specifically for treatment of your scarring alopecia?

Group B Questions

2. When you compare a good series of 10-12 photos taken 2 years ago to another good series of 10-12 photos taken today, do you agree that some images show that you have lost more hair compared to 2 years ago?
3. Do you feel there are less hair follicles on the scalp today compared to 2 years ago?
4. Do you feel your eyebrow density is currently less than what it was 2 years ago?
5. Do you feel your eyelash density is currently less than what it was 2 years ago?
6. Did you need any hair loss medications in the last 2 years to keep your scalp feeling calm or to keep it from flaring?

Group C Questions

7. Do you experience periods of time in the last 2 years where you had some degree of scalp burning?
8. Did you experience periods of time in the last 2 years where you had any tender areas on the scalp (like a bruise)?
9. Did you experience periods of time in the last 2 years where you had pimples or bumps forming on the scalp?

Group D Questions

10. Did you experience periods of time in the last 2 years where you had prolonged scalp itching (more than just an occasional itch every few month)?

11. Did you experience periods of time in the last 2 years where your scalp gets redder than you feel is normal?

12. Do you feel your scalp is currently more red than what you would say is normal?

Group E Questions

13. Do you feel your daily hair shedding is currently above what you feel is normal?
14. Did you experience periods of time in the last 2 years where you had increased hair shedding above what you feel is normal?

Burnt out Inactive Cicatricial Alopecia and Treatment Induced Inactive Cicatricial Alopecia

If all of the answers are no, there is a very high chance that the person has burnt out scarring alopecia ! The proper term for this is 'burnt out’ inactive cicatricial alopecia (BO-ICA). A hair specialist can of course confirm when they review all the information and examine the scalp. But these are the features of BO-ICA.

If the patient answers “yes” to the group A questions, but “no” to all the group B, C, D and E questions, then there is a good chance that the scarring alopecia is what we call treatment induced inactive cicatricial alopecia (TI-ICA). A hair specialist can of course confirm when they review all the information and examine the scalp. But these are the features of TI-ICA.

Reduced Likelihood of True BO-ICA

There are several situations whereby the chance that the patient in front of you truly has burnt out scarring alopecia starts decreasing.

a) If the patient answers “no” to all group A, B, C, and D questions but “yes” to one or more group E questions, there is a high likelihood that the scarring alopecia is burnt out but it’s by no means definite. There is now a very small chance that the scarring alopecia is, in fact, a tiny bit active. A dermatologist can confirm following proper review of the history and examination of the scalp.

b) If the patient answers “no” to all group A, B, and C questions but “yes” to one or more group D questions, there is a moderate likelihood that the scarring alopecia is burnt out but it’s even less definite. There is now a small chance that the scarring alopecia is, in fact, active. A dermatologist can confirm following proper review of the history and examination of the scalp.

c) If the patient answers “no” to all group A and B questions but “yes” to one or more group C questions, there is a moderate likelihood that the scarring alopecia is NOT a so called “burnt out” inactive scarring alopecia. There is now a pretty good chance that the scarring alopecia is, in fact, active. A dermatologist can confirm following proper review of the history and examination of the scalp.

d) If the patient answers “no” to the group A question but “yes” to one or more group B questions, the scarring alopecia is not likely to be a “burnt out” inactive scarring alopecia. A dermatologist can confirm following proper review of the history and examination of the scalp.