National Scarring Alopecia Awareness Month (Day 22, Myth 7): What is the significance of "sprouts" of hair?

“Sprouts” of Hair Regrowth in Scarring Alopecia: What does it mean? …. What doesn’t it mean?

There are two things that particularly cause me to age. These are birthdays and hearing patients and physicians conclude that a certain treatment for scarring alopecia must be helping because they see “new sprouts of hair.”

I can’t do all that much about the birthdays but I can about the last point - and so I type out this article today.

As surprising as it sounds, seeing “new sprouts of hair” does not necessarily mean a treatment is helping!

SCENARIO 1

New hair growth can be a sign several things. It can be a sign that the treatment itself is causing new growth (scenario 1). This is of course wonderful and the hope would be that this leads to an improvement in hair density. For patients with scarring alopecia, this is usually accompanied by a reduction in overall shedding or a reduction in symptoms like itching or burning or redness. The pull test becomes negative (if it was once positive). Hair regrowth does not always occur in scarring alopecia but certainly it’s a possibility in early stages and with aggressive treatment.

SCENARIO 2

New growth can be a sign that the treatment actually caused hair loss just a few weeks or a few months prior and now what is being seen is the “recovery” of shed hairs (scenario 2). All this new growth looks exciting but is not. The hair growth is a recovery not a surplus. The result is no change in density or possibly a slight reduction in density if recovery is incomplete. In this case patients do not have a reduction in symptoms usually and do not have a reduction in redness or overall shedding. There is initially an increased shed, followed by a recovery and then a return back to the original density (or close to it hopefully).

SCENARIO 3

Seeing new growth can be a sign that the patient is just growing hair like all humans do (scenario 3). There will always be some new growth found on the scalp in patients with scarring alopecia - even if the disease is incredibly active! Hair is resilient and always tries to regrow no matter the circumstances. In this scenario, there is new growth seen but not “net improvement.” There is no change in symptoms or signs and no change in shedding.