Cicatricial alopecia is commonly known as scarring alopecia. It refers to a group of diseases that not only destroy the hair follicles, but also replace them with scar tissues, thereby causing scarring and permanent hair loss. It can affect both men and women, irrespective of their age. Causes There are mainly two types of cicatricial alopecia - primary and secondary. In primary cicatricial alopecia, the hair follicles are destroyed by an inflammatory process, which can be triggered by lymphocytes, neutrophils, or other inflammatory cells. Such a condition can be caused by autoimmune disorders. Depending on the type of the inflammatory cells involved, primary cicatricial alopecia is further classified into three main types - lymphocytic, neutrophilic, and mixed alopecias. On the other hand, secondary cicatricial alopecia results from factors like burns, and injuries or severe infections that leave scars on the scalp, and cause hair loss on the affected area. Even people having tumors and those exposed to radiation can develop this condition. In addition to these, it may be associated with some other medical conditions, like systematic or cutaneous lupus erythematosus and scleroderma. Some other conditions that can cause the scarring of the scalp and hair loss are, inflammation of the hair follicles, fungal, bacterial, or viral infections, folliculitis decalvans, scalp ringworm, lichen planus, and granulomatous diseases. Scarring alopecia is basically believed to be caused by an inflammatory process that attacks the stem cells and the sebaceous glands, located in the upper part of the hair follicles. The destruction of the stem cells eventually causes permanent hair loss, as they are replaced by scar tissues. Signs and Symptoms It often manifests itself in gradual hair loss and scarring. Occasionally, it may be accompanied by itching, pain, and a burning sensation. Initially, the condition causes hair loss in small patches, which eventually expand over a period of time. The bald patches caused by this condition are characterized by edges. In addition to these, the affected area may look red and scarred. Sometimes, blisters can also develop on the affected area. Treatment Physicians usually examine the skin of the affected area, and the pattern of hair loss to diagnose this condition. Sometimes, a skin biopsy can also be required to identify the specific type or form of the condition. The treatment is mainly determined by the particular form of the disorder. Steroids or corticosteroids are generally used when lymphocytes are responsible for causing the inflammation and the destruction of the hair follicles. Creams containing corticosteroids can be applied on the affected area of the scalp, or steroids can be administered on the area with the help of injections. If bacterial infections are responsible for causing this condition, then antibiotics can be required for its treatment. Even antimalarial and isotretinoin are used for treating this condition at times. Both antibiotics and isotretinoin are used, if the inflammation is caused by neutrophils or other cells. Physicians can also opt for the surgical removal of the bald patches, if there is no possibility of containing the gradual destruction of the hair follicles. Subsequently, hair transplantation can be performed to restore hair on those areas. So, cicatricial or scarring alopecia is not a single disorder, but a group of rare disorders, that cause permanent hair loss in both men and women. According to estimates, it accounts for about 3% of the total cases of hair loss. The treatment of this condition basically depends on the underlying causes and the exact form of the disease. So, it is imperative to consult a physician for the accurate diagnosis of this condition. Disclaimer: This article is for informative purposes only, and should not be treated as a substitute for professional medical advice.