Treating Scarring Alopecia: What’ s the point?
The scarring alopecias are a group of hair loss conditions whereby patient’s lose hair in a manner that has the potential to be permanent. The reason the hair loss may be permanent is that these conditions are associated with the depositing of tiny bits of scar tissue beneath the scalp that make it difficult for hair to regrow. Treatments are often used to help stop the process, although sometimes regrowth is possible. Regrowth is more of an option when treatments are used in the earliest stages of the disease. In more advanced stages, regrowth generally does not occur.
Why treat if I’m not going to regrow anything back?
Patients often ask me why they should bother treating if they can’t grow back any hair. Sometimes this is said in frustration but other times after much thought about the whole process. Here are some important considerations as to why some patients decide to try to treat their scarring alopecia despite the fact that that hair is not going to come back for many people:
1. I want to save whatever hair I have now. Some patients choose to begin treatment to save the hair that they have. They understand that getting more hair back is not likely to occur but want to hold on to whatever they have. They want to have the ability to style the hair they have now and use the existing hair to camouflage thinning areas.
2. I want to stop my symptoms of itching and burning. Scarring alopecias can be associated iwth troublesome scalp symptoms like itching, burning and tenderness. Some patients choose to begin treatment to stop their symptoms regardless of what effect it will have on hair growth or loss. Not all patients with scarring alopecia have symptoms but for some patients the intensity of symptoms can be quite high. it’s not uncommon for itching, burning for some patients to reach levels of 6-10 out of 10 (with 10 being maximal itching and burning that one can imagine).
3. I would like to keep the hair they have now so my hairpeice, wig or system fits better on the scalp. Some patients want to hold on to their hair so that their current wig or hairpeice has something to attach to or so that it blends in better with their existing hair. Consider the middle age male with lichen planopilaris that I saw last week. He is wearing a hair system and it looks terrific. The top of the scalp is shaved and the system is attached to the top of the scalp with use of adhesive. It blends in quite unnoticeable with this hair around the sides and the back. The main issue for him is that he also has lichen planopilaris (scarring alopecia) affecting the sides and the back and this area is at great risk for being lost too. If this area were lost the current system might not camouflage as effectively. We are doing everything we can to save the hairs around the sides and back. Regrowth of hair is not a point of discussion here.
Summary and conclusion
The early and aggressive treatment of scarring alopecia can sometimes lead to a bit of improvement in hair density - but not always. Many patients with scarring alopecia chose to begin treatment even though getting back hair is not one of the goals. For some the decision to start treatment centers around the hope to hold on to whatever they have. For others, it’s centered around setting or stopping troublesome scalp symptoms like itching or burning.
Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Whistler office at 604.283.1887