The Truth Behind Sciatrical Alopecia

Sciatrical alopecia will cause the destruction of the hair follicle completely as so cause permanent hair loss, the following are some of the usual problems which cause this, but is by no means an extensive list.

March 2011

Consultant Trichologist Iain Sallis is the only hospital-based trichologist in the UK with seven clinics spanning the country. Treating symptoms and problems such as male and female pattern hair loss, thinning hair, alopecia and many types of scalp conditions, trichologists are hair scientists who work to try and understand the underlying problems causing hair and scalp issues.

What is Scarring Alopecia?

Scarring Alopecia or ‘sciatrical alopecia’ is a form of hair loss that causes the destruction of the hair follicles leaving scar tissue on the area of the scalp with the hair loss, so the hair cannot re-grow back. It is usually a slow painless progression that can ‘creep’ up unexpectedly.

Misdiagnosis – dry scalp it ain’t!

Unfortunately a lot of misdiagnosis happens when the patient presents a ‘red, bumpy’ scalp to the Doctor as it can very easily be dismissed as psoriasis or a dry scalp!

If this rings any bells or you suspect this may be happening to you, please ask your GP for an appointment to see a dermatologist - those are the specialists who will be able to give you the correct medication and diagnosis required. (Do not take the word of your GP in this case!)

The problem with diagnosis of these scalp problems is that they look very much the same when they are ‘active’ and almost indistinguishable once they have caused the damage leaving the scar.
There are some tell tale signs to differentiate between types, but this must be done by a specialist (dermatologist)

The diagnosis is ‘nearly’ the same for each type, an area of hair loss that in its active form looks red, angry and rough to the touch and in its ‘burnt out’ form leaves very smooth skin that wrinkles up when pinched and is devoid of hair follicles completely.

How does it differ from ‘normal’ alopecia?

Unlike the usual ‘alopecia’ which people are more used (areata etc..), Sciatrical alopecia will cause the destruction of the hair follicle completely as so cause permanent hair loss, the following are some of the usual problems which cause this, but is by no means an extensive list.

The types:

Several types of Sciatrical alopecia exist, and some attack the skin/hair in different patterns:

1.) Frontal fibrosing alopecia; has been described only recently and is quite uncommon. Its name reflects hair loss and scarring in the frontal region of the scalp (the front hair line).

Signs and symptoms of Frontal fibrosing alopecia?

Frontal fibrosing alopecia usually affects post-menopausal women over the age of 50. It is characterised by hair loss on the front and sides of the scalp. The skin in the affected area usually looks normal but may be pale or mildly scarred. There may be mild redness around the hair follicles at the margins.

The hair slowly retreats backward, to give an (Queen Elizabeth I) type of hair line, the skin in the receded area is smooth and shiny, and no follicles are present.


2.) Folliculitis declavans; Is characterised by redness and swelling and pustules around the hair follicle (folliculitis) that leads to permanent hair loss.

The exact cause is unknown. In most cases Staphylococcus aureus can be isolated from the pustules but the role of the bacteria is not clear.

Signs and symptoms of Folliculitis declavans?

There are usually round or oval patches of hair loss in which there are pustules surrounding the hair follicles. Characteristically, several or many hairs can be seen coming out of a single follicle, so the scalp looks "tufted" like a toothbrush. Eventually the hairs are shed as the follicle is completely destroyed and leaves behind a scar.

Usually there are no symptoms but sometimes the affected area may be itchy. The disease may remain limited to a few small patches or may progress over time causing extensive hair loss.


3.) Lichen planus: This problem is thought to be due to an abnormal immune reaction which can also be provoked by a viral infection (such as hepatitis C) or a drug. Inflammatory cells seem to mistake the skin cells as foreign and attack them.

Signs and Symptoms of Lichen planus?

Lichen planus (in its active form) may cause lots of hard plugs which are all just above a hair follicle, this causes a ‘nutmeg’ grater effect on the scalp, making it rough to the touch.

Permanently bald patches may develop. Sometimes no follicular scaling or inflammation is present but bald areas of scarring slowly appear, often looking rather like footprints in the snow. This is known as ‘pseudopelade’. Frontal fibrosing alopecia is thought to be a limited form of lichen planopilaris.

If your skin has changed at all and there is no hair where their once was, you may be dealing with a Sciatrical alopecia and need treatment from a specialist fast, the quicker you get treatment, the less hair you will loose.