National Scarring Alopecia Awareness Month (Day 25, Myth 10): Lack of Symptoms and Redness Does not Always Indicate Inactive Disease

Does a Lack of Symptoms or Lack of Scalp Redness Mean a Scarring Alopecia is Inactive?

It’s not always correct that a patient with scarring alopecia who no longer has scalp symptoms and no longer has scalp redness has inactive disease.

The “first step” in treating scarring alopecia is to connect patients to one or more treatments that can stop redness (if there was any to begin with) and stop symptoms (if there were any to begin with) and stop abnormal shedding (if it was abnormal to begin with).

The “second step” is to see if the first step actually stopped the disease and prevented hair loss.

Sometimes, a patient will note that the treatments they use are very good at addressing step 1 but don’t seem to address step 2 quite as well as hoped. In other words, the treatment stops symptoms, stops redness and stop shedding .... but the actual hair loss still continues.

I am “cautiously optimistic” when patients achieves the goals of step 1. In other words, I am always very happy when a patient reports that redness goes away, shedding stops and symptoms disappear. The next step is to monitor the scalp carefully to determine if hair loss has truly stopped. Sometimes hair loss has not, in fact, stopped and more aggressive treatments are needed.

One can not simply conclude that a disappearance of scalp symptoms and signs indicates the disease has disappeared and become inactive. Often it has and there is no doubt about it that achieving the goals of step 1 is a reason for celebration. But one must still stand watch to see if the hair loss continues or not.