Hair Loss Alopecia With Scarring Information
Scarring alopecias cause destruction of follicles and therefore there is no potential for regrowth. Scarring alopecias can be classified as primary or secondary. In primary scarring alopecias, the follicle is the target of inflammation. In secondary scarring alopecias, the follicle is an innocent bystander that nevertheless is destroyed. Examples of secondary scarring alopecias include morphea and tumors (alopecia neoplastica). In this lecture we will consider only the primary scarring alopecias.
In this group of diseases, the inflammation can be primarily lymphocytic or neutrophilic. Although all parts of the follicle can be involved, the disease is felt to destroy the bulge area of the follicle, where the arrector pili muscles insert. This area contains the follicular stem cells necessary for regeneration of the lower follicle during normal follicular cycling. When this part of the follicle is destroyed, the follicle is doomed. The sebaceous glands are also destroyed in primary scarring alopecias. The destruction of these structures and the dermal fibrosis results in skin that is firm and shiny, and lacking in follicular orifices.