Can Hair Grow Back After Scarring Alopecia?

Spontaneous regrowth of hair hardly ever occurs after scarring alopecia. Also known as cicatricial alopecia, it is a disorder that destroys hair follicles, replaces them with scar tissues and causes permanent hair loss. The symptoms include central hair loss, scarring, and occasionally inflamed scalp presenting as redness, pustules, scales, pain and itching. Inflammation in scarring alopecia damages the stem cells in the hair follicles bulge and forms scar tissues. Once stem cells are completely destroyed, it is impossible for hair follicles to regenerate, resulting in a smooth and bare scalp. A biopsy is often confirmative of the diagnosis. This disease also negatively impacts the self-image and self-esteem of the patients. For most cases, cicatricial alopecia hair transplant can be a lifesaver for a more confident self-image.

Fortunately, not all hopes are lost for those who desire to regrow their hair. Early treatments including medications and lifestyle changes have shown to be beneficial to those who presented the disease in the early stages, such as patients with ongoing hair loss or inflamed scalp. At this stage, the stem cells in the hair follicles are not completely destroyed and are still salvageable. Spontaneous hair growth at peripheral areas of the scalp may be possible with the proper treatment. Effective medications like topical corticosteroids and oral tetracyclines antibiotics have anti-inflammatory properties that can halt the inflammatory processes, thus reducing the symptoms and preventing the formation of scars.

In addition, harmful hair care practices and products should be avoided at all times to prevent unnecessary hair loss. For instance, chemical or thermal hairstyling should be avoided as they can damage healthy hair and make it more difficult to camouflage hair loss. If necessary, minimise the usage of chemical hair relaxers. Hairstyles that involve excessive pulling on hair follicles like braiding is also not advisable. Haircare products and shampoos are considered safe if they are non-irritating to the scalp. Consult your dermatologists for recommended hair care products.

For individuals with late-stage or stable scarring alopecia with no symptoms for more than 2 years, surgical cosmetic treatments are the best option for hair regrowth. This includes hair transplantation, surgical excision of scarred area, flap surgery, and scar reduction with tissue expansion.

Recently, hair transplantation has become a popular method for treating hair loss. Since the 1930s, successful hair transplants had been reported in Japanese literature. In 1968, autologous hair transplantation was used to treat scarring alopecia. It is a procedure which involves grafting a piece of the patient’s skin that contains healthy hair follicles and transplanting it to the area of the scalp with hair loss. Gradually, large grafts used in the 1960s were replaced by mini grafts in the 1980s and mini-micrografting in the 1990s. The latest method of hair transplantation was introduced in 2002, called the “Follicular Unit Extraction”, or FUE in short. This method harvests micrografts (nearly 1mm) from the healthy skin of patients and transplants them into pre-drilled holes at the affected areas. Currently, this method is preferred for hair transplantation in scarring alopecia, especially for those with large areas of balding. FUE may have minimal scarring but it is not scar proof. Hair transplantation surgery is relatively safe with few preventable complications such as infections and visible scarring.

Another method of surgical treatment for scarring alopecia is surgical excision of scarred areas. For individuals with small areas of balding, removal of scarred areas is done by making incisions on the scalp, undermining the wound edges and bringing them together with as little tension as possible. For those with larger areas (more than 5cm), tissue expanders are inserted. Possible complications include infections, seroma formation and wound dehiscence. Hair transplantation is often necessary to combine with this technique, especially in cases of too large areas, too close to the hairline or to give a smooth transition from normal area to the excised area of the scalp.