INTRODUCTION

Cicatricial or scarring alopecias comprise a diverse group of scalp disorders that result in permanent hair loss. The destructive process can occur as a primary or secondary cicatricial alopecia. Primary cicatricial alopecia refers to a group of idiopathic inflammatory diseases, characterized by a folliculocentric inflammatory process that ultimately destroys the hair follicle. Secondary cicatricial alopecias can be caused by almost any cutaneous inflammatory process of the scalp skin or by physical trauma, which injures the skin and skin appendages. Regardless of whether a cicatricial alopecia is primary or secondary in nature, all scarring alopecias are characterized clinically by a loss of follicular ostia and pathologically by a replacement of hair follicles with fibrous tissue.

Cicatricial alopecias are psychosocially distressing for the affected patient and medico-surgically challenging for the treating physician.

Hair restoration surgery in cicatricial alopecia is possible when the patient has a suitable occipital donor area and the scarring alopecia, and its underlying inflammatory process has reached a “burnt-out” stage. However, graft survival rates and cosmetic outcome may be diminished due to changes in skin properties such as fibrosis and limited blood supply. Moreover, one must consider that a reactivation of the inflammatory process may occur at any time after surgery.

This chapter is a brief review of primary and secondary cicatricial alopecias. Emphasis is placed on their clinical recognition, on patient management and treatment options as well as on their amenability to hair restoration surgery.