Scarring Hair Loss

Scarring hair loss, also called cicatricial alopecia, can damage the hair follicle and may lead to permanent hair loss if active inflammation is not addressed.

Signs such as itching, burning, tenderness, redness, scaling, pustules, smooth shiny areas, or loss of follicle openings should not be ignored. A trichology assessment can help identify concerning scalp signs and guide the right next step, including medical referral where needed.

At Carmen Du Preez Trichology in Perth, this type of concern is approached carefully because early medical input may be important.

What Is Scarring Hair Loss?

Scarring hair loss refers to hair loss conditions where the hair follicle may be damaged and replaced by scar-like tissue.

When this happens, the follicle may no longer be able to produce hair in the affected area.

Scarring hair loss can occur in different patterns and may affect the scalp in patches, along the hairline, around the crown, or across wider areas depending on the condition involved.

Because the damage can become permanent, suspected scarring hair loss should not be ignored.

What Does Scarring Hair Loss Look Like?

Scarring hair loss can look different from person to person.

Possible signs may include:

• Smooth shiny areas of hair loss

• Loss of visible follicle openings

• Patchy hair loss

• Hair loss around the front hairline or temples

• Redness around follicles

• Scaling or flaking around hairs

• Scalp tenderness

• Burning, itching, or discomfort

• Pustules or small bumps in some cases

• Gradual spreading of affected areas

• Hair that does not appear to regrow in the affected area

Some people have symptoms such as burning, itching, tenderness, or pain. Others may notice hair loss without much discomfort.

Types of Scarring Hair Loss

There are different forms of scarring, or cicatricial, alopecia.

Examples include:

• Frontal fibrosing alopecia

• Lichen planopilaris

• Central centrifugal cicatricial alopecia

• Discoid lupus erythematosus affecting the scalp

• Folliculitis decalvans

• Traction-related scarring in advanced cases

These conditions may require medical diagnosis and management. A trichology consultation can help identify signs that may require referral to a GP or dermatologist.

Why Early Assessment Matters

Early assessment is especially important with suspected scarring hair loss.

In some cases, once the hair follicle has been permanently damaged, regrowth may not be possible in that area. The aim is often to identify warning signs early, reduce delays, and guide appropriate referral where medical treatment may be needed.

If you notice symptoms such as scalp burning, tenderness, redness, scaling, pustules, or hair loss that appears smooth or shiny, it is important to seek assessment.

How Is Scarring Hair Loss Different From Other Hair Loss?

Scarring hair loss is different from non-scarring hair loss because the follicle itself may be permanently damaged.

Non-scarring types of hair loss may include:

• Telogen effluvium

• Female pattern hair loss

• Male pattern hair loss

• Alopecia areata

• Temporary shedding after stress, illness, surgery, or weight loss

These types do not always destroy the hair follicle.

Scarring hair loss, however, can involve inflammation that damages the follicular structure. This is why it often needs prompt medical assessment.

Common Symptoms to Watch For

You may notice one or more of the following:

• Itching

• Burning

• Tenderness

• Pain

• Redness

• Scaling

• Flaking around follicles

• Small bumps or pustules

• Smooth areas where hair has disappeared

• Hairline recession with scalp symptoms

• Loss of eyebrow hair in some cases

• Gradual spreading of hair loss

Scalp symptoms should not be dismissed, especially when they occur with hair loss.

Frontal Fibrosing Alopecia

Frontal fibrosing alopecia is a type of scarring hair loss that often affects the front hairline and temples.

It may cause gradual recession of the hairline and can sometimes involve eyebrow thinning or loss. Some people also experience itching, redness, or scaling around the hair follicles.

This condition is more commonly seen in women after menopause, although it can occur in other groups as well.

If frontal fibrosing alopecia is suspected, assessment is important.

Lichen Planopilaris

Lichen planopilaris is another type of scarring hair loss involving inflammation around the hair follicles.

It may cause patchy hair loss, scalp redness, scaling, itching, burning, or tenderness. The affected areas may gradually expand if the inflammation continues.

Management is important where lichen planopilaris is suspected.

Central Centrifugal Cicatricial Alopecia

Central centrifugal cicatricial alopecia, often shortened to CCCA, is a type of scarring hair loss that commonly begins around the crown or centre of the scalp.

It may slowly spread outward over time. Some people experience tenderness, itching, burning, breakage, or reduced density in the affected area.

Because CCCA can become permanent if follicle damage progresses, early assessment is important.

Can Hair Grow Back With Scarring Hair Loss?

Hair regrowth depends on whether the follicle is still active or whether permanent damage has occurred.

In areas where the follicle has been destroyed, regrowth may not be possible. In areas where inflammation is active but the follicle has not yet been permanently damaged, early management may help reduce further progression.

This is why prompt assessment and referral are important when scarring hair loss is suspected.

Can Blood Tests Be Relevant?

Blood tests may be relevant in some cases, especially where there are symptoms, medical history, or signs suggesting broader inflammatory, autoimmune, hormonal, or nutritional factors.

Depending on the situation, your GP or healthcare provider may consider tests such as:

• Full blood count

• Iron studies

• Ferritin

• Vitamin D

• Vitamin B12

• Folate

• Thyroid function

• Inflammatory markers

• Autoimmune-related testing where appropriate

Blood tests do not diagnose every type of scarring hair loss. In many cases, medical assessment, trichoscopy, and sometimes scalp biopsy may be needed for diagnosis.

How a Trichology Consultation Can Help

A trichology consultation can help identify signs that may suggest scarring hair loss and guide appropriate next steps.

At Carmen Du Preez Trichology, your consultation may include:

• Detailed discussion of your hair loss and scalp symptoms

• Review of when the concern started and how it has changed

• Assessment of hair loss pattern

• Hair and scalp examination

• High-magnification trichoscopy

• Review of relevant history and blood test results where appropriate

• Identification of visible signs such as redness, scaling, follicular changes, shiny areas, or loss of follicle openings

• Discussion of possible contributing factors

• Guidance on whether GP or dermatologist referral may be appropriate

A trichologist does not replace a GP or dermatologist. Where scarring hair loss is suspected, medical referral may be recommended for diagnosis, prescription treatment, biopsy, or specialist management.

When Should You Book a Consultation?

You may benefit from booking a consultation if you notice:

• Hair loss with itching, burning, tenderness, or pain

• Smooth or shiny areas of hair loss

• Hair loss where follicle openings appear reduced or absent

• Redness or scaling around hair follicles

• Pustules or bumps on the scalp

• Gradual recession of the front hairline

• Patchy hair loss with scalp symptoms

• Crown thinning with tenderness or burning

• Eyebrow thinning along with hairline recession

• Hair loss that appears to be spreading

• Hair loss that is not regrowing

These signs should be assessed promptly.

Book a Scarring Hair Loss Consultation in Perth

If you are concerned about possible scarring hair loss or cicatricial alopecia, a trichology consultation can help assess visible signs and guide the most appropriate next steps.

Carmen Du Preez Trichology offers hair and scalp consultations in Perth, including detailed case history, scalp assessment, trichoscopy, and review of relevant blood test results where appropriate.

Book an initial trichology consultation to better understand your scalp and hair loss concern and determine whether medical referral may be needed.

​​

​

Related reading:

• Hair Loss and Scalp FAQs

• What to Expect

• Contact Us