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RO In scarring alopecia the follicle is destroyed, not shrunk. Inflammation damages the stem cell region and the follicle is replaced by fibrous tissue. This is the dividing line in all hair loss: pattern loss leaves follicles in place producing smaller hair, so it is potentially reversible; cicatricial alopecia removes them, and that is permanent.
| Non-scarring | Scarring (cicatricial) | |
|---|---|---|
| Follicular openings | Still visible on the skin | Lost; the surface looks smooth |
| Follicle | Present, miniaturizing | Replaced by fibrous tissue |
| Skin | Normal | May be red, scaly or shiny |
| Reversible | Potentially | No |
The loss of visible pores is the clinical sign. On a normally thinning scalp the openings are still there, even where hair is fine. Where they have disappeared and the skin looks smooth or shiny, the process is a different one and needs a dermatological diagnosis rather than a surgical plan.
Surgery is not the first question. Grafts placed into actively inflamed scalp can be lost, and the underlying process can be provoked by the trauma of surgery. Transplantation is considered only where the disease has been quiet for a sustained period, and even then with a test session and guarded expectations, because the recipient bed is compromised tissue.
Related terms
For one specific scarring form and how it presents, see frontal fibrosing alopecia. For hair loss caused by tension rather than inflammation, see traction alopecia.
