Scarring Alopecia: Is there any chance of regrowth?

Regrowth in Early Treatment of Scarring Alopecias

Regrowth in a patient with scarring alopecia following aggressive treatment

The classic teaching that physicians often learn is that the hair loss that occurs in scarring alopecias is permanent. In other words, physicians often explain to patients that “what you have lost is lost for good and the goal of treatment is to stop it from getting any worse.” We know now that this statement is not quite accurate.

The very early stages of scarring alopecia are associated with inflammation which causes hairs to shed.  It’s not so easy for hairs to grow in a soup of inflammation. However, if the inflammation can be stopped some of these hairs can regrow because there are still stem cells left inside the original hair follicle tract. The early and aggressive treatment of lichen planopilaris, frontal fibrosing alopecia, central centrifugal cicatricial alopecia, discoid lupus and dissecting cellulitis can all be associated with some degree of regrowth. Of course the regrowth is not always 100 % but it can be quite signficant.

The above photo shows massive amounts of regrowing hair in a patient with lichen planopilaris who started hydroxychloroquine, topical steroids and steroid injections about 6 months prior.