Does this look like scarring alopecia? (Photo)

Question

I have been shedding and itching for 7 months. Was diagnosed with seb derm, TE, and MPB. Used Keto 2%, clobetosol, doxycycline, and am trying 2.5% selenium sulfide. Nothing seems to work. I’ve noticed a completely bald spot that my derm suspects may be a scar. However, he noted no abnormalities in the rest of my hair. I’m skeptical since I’ve noticed a widening of my part and lots of hair on my pillow and in the shower. I’m desperate to stop the itching. Do the pictures look like it’s permanent?

Jeff Rapaport, MD · Answer

The workup to rule out scarring alopecia with scaling of the scalp and hair loss typically involves a thorough clinical evaluation, diagnostic tests, and a biopsy to confirm the diagnosis. Here's a  breakdown: Diagnostic Tests-
   -Scalp Scraping : If there is scaling present, a sample of the scales may be collected and examined under a microscope to check for the presence of fungi, which could indicate a fungal infection like tinea capitis.
   -Blood Tests: Blood tests may be ordered to assess for underlying conditions such as autoimmune diseases (e.g., lupus), hormonal imbalances (e.g., thyroid disorders), or infections.
   -Trichoscopy:  Trichoscopy involves using a special handheld device to magnify and examine the scalp and hair follicles in detail. It can help identify specific features associated with scarring alopecia, such as follicular plugging, perifollicular erythema, or loss of follicular openings.
   -Skin Biopsy : A skin biopsy is necessary to confirm the diagnosis of scarring alopecia definitively. This involves removing a small sample of affected scalp tissue for examination under a microscope. The biopsy can reveal characteristic features such as destruction of hair follicles, inflammation, and fibrosis (scar tissue).
Once a diagnosis is confirmed, the dermatologist can develop a comprehensive treatment plan tailored to the specific type of alopecia identified. 
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Jeff Rapaport MD FAAD 
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Matt Tahsini, MD · Answer

Hello and thank you for your question.  This could be early scarring alopecia but you'll need to see a dermatologist in order to be sure. Find a reputable doctor in order to get the proper diagnosis.  Best of luck to you.

Dr. T

Wipawan Vathananai, MD · Answer

From the photos, I can see a well-defined hair loss patch which could be alopecia areata or early scarring alopecia. I think it is very important that you seek for a dermatologist specialized in hair diseases in order to get the right diagnosis and treatment. For the meantime, I would recommend you to use clobetasol on that bald patch if you still have it. Please try to book an appointment as soon as possible. I hope this help.

Jeff Donovan, MD, PhD · Answer

Thank you for the interesting question. It would be great to see more photos and up close ones. One thing is for sure: this is more than AGA, TE and SD. While it could be a scarring alopecia, there’s not enough evidence here to support this 100 %. A cyst is possible, for example. But if someone suspects a scarring alopecia, a biopsy might be considered. Pseudopelade and lichen planopilaris are in the differential of hair loss like this but so is alopecia and aseptic nodules of the scalp (AANS), alopecia areata and others. Be sure to continue your discussions with an expert!

Does this look like scarring alopecia? (Photo)

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Answer: Is it a scar?

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Does this look like scarring alopecia? (Photo)

Answers (4)

Answer: Is it a scar?

Answer: Is it a scar?

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