Scarring Alopecia: Is it inactive?

Is it inactive?

There are many misconceptions when it comes to determining if a scarring alopecia is truly “quiet.” Scarring alopecias, are a group of hair conditions whereby the body forms scar tissue in the scalp. This scar tissue ultimately prevents hairs from growing properly.

Here are a few principles that should always be considered when one feels they want to say a scarring alopecia is “quiet” or “inactive” 1) No doctor can tell if a scarring alopecia is quiet by looking at the scalp on a first appointment visit. That sentence deserves reading twice. Some scarring alopecias look quiet but the patient continues to lose hair. You can really only say a scarring alopecia is quiet if you’ve re-examined the scalp 12-24 months after the first appointment. 2) A patient with scalp symptoms like itching, burning or pain probably does not have quiet (inactive) disease. 3) Patients with redness and scaling in the scalp probably have active disease but they may not. Redness can be a sign of active disease but some patients with prolonged use of topical steroids simply have a red scalp. 4) The most important (and too often forgotten) guide that determines if a scarring alopecia is “quiet” is a comparison of scalp photographs taken at two different time points. Provided the interval between photos is greater than 1 year, one can get some pretty good information about whether the condition is quiet.

In my opinion, if there is no change in hair density between 2 photographs taken ONE year apart, the scarring alopecia is “probably” quiet (inactive). If there is no change in hair density between 2 photographs taken TWO years apart, the scarring alopecia is “extremely likely” to be deemed quiet. Despite this inactive appearance, the scarring alopecia STILL carries a risk of reactivation.

If there is no change in hair density between 2 photographs taken THREE years apart, and the patient is OFF MEDICATION during that period of observation, the scarring alopecia is likely burnt out.