Understanding Different Types of Hair Loss - Scarring vs. Non-Scarring
Hair loss can be distressing, regardless of the cause. But not all hair loss is the same—and understanding the difference between scarring and non-scarring alopecia is key to finding the right diagnosis and treatment. At Premier Dermatology & Aesthetics in New York, Dr. Adam Nabatian, a double board-certified dermatologist, specializes in diagnosing the cause of hair loss and creating personalized treatment plans to help patients restore healthy hair and confidence.
The Two Main Categories of Hair Loss
Dermatologists classify hair loss into two main categories: scarring (cicatricial) and non-scarring alopecia. Both can cause thinning or bald patches, but they differ in what happens to the hair follicle itself.
Non-scarring hair loss means the hair follicle remains intact, so regrowth is possible once the underlying cause is treated.
Scarring hair loss involves permanent follicle destruction due to inflammation, autoimmune activity, or other damaging processes. Once scarring occurs, hair cannot regrow in that area.
Knowing which type you have is the first step toward effective management.
Common Types of Non-Scarring Hair Loss
Non-scarring alopecia is more common and often reversible when addressed early. Common conditions include:
1. Androgenetic Alopecia (Male or Female Pattern Hair Loss)
This is the most common form of hair loss, driven by genetics and hormones. Men typically experience receding hairlines and thinning at the crown. While in women it usually starts with a widening through the center hair part and can progress to diffuse thinning over the scalp. Treatments like topical minoxidil, oral medications, and PRP therapy can help slow progression and promote regrowth.
2. Telogen Effluvium
A temporary form of shedding caused by stress, illness, surgery, nutritional deficiencies or hormonal changes. Hair typically regrows within several months once the trigger is resolved.
3. Alopecia Areata
An autoimmune condition where the immune system attacks hair follicles, causing smooth, round bald patches. While unpredictable, regrowth often occurs with treatments like steroid injections or topical immunotherapy.
4. Traction Alopecia
Caused by tight hairstyles or constant tension on the scalp. Early intervention and hairstyle changes can allow hair to regrow before permanent damage occurs.
Common Types of Scarring Hair Loss
Scarring (cicatricial) alopecia involves inflammation that destroys the follicle and replaces it with scar tissue, resulting in permanent hair loss. These conditions are often diagnosed through a scalp biopsy and close dermoscopic examination.
1. Lichen Planopilaris (LPP)
An autoimmune condition that causes scalp inflammation and destruction of hair follicles, often seen in middle-aged women. Early treatment with topical or oral anti-inflammatory medications can slow progression.
2. Central Centrifugal Cicatricial Alopecia (CCCA)
Common among women of African descent, CCCA starts at the crown and gradually spreads outward. Contributing factors may include genetics, heat styling, or chemical treatments.
3. Discoid Lupus Erythematosus (DLE)
A chronic autoimmune skin condition that can cause scarring patches on the scalp. Treatment typically includes steroids and immunosuppressive therapies to prevent further loss.
4. Folliculitis Decalvans
A rare but chronic bacterial condition that leads to pustules, crusting, and progressive scarring. It often requires antibiotics or anti-inflammatory therapy to control inflammation.
How Hair Loss Is Diagnosed
At Premier Dermatology & Aesthetics, Dr. Nabatian uses advanced diagnostic tools such as dermoscopy and scalp biopsies to identify the exact type of alopecia. Dermoscopy allows for a magnified look at follicular patterns, inflammation, and scaling, key indicators of whether hair loss is scarring or non-scarring.
A thorough evaluation often includes:
Review of medical and family history
Scalp examination and dermoscopic imaging
Bloodwork to rule out nutritional or hormonal causes
Scalp biopsy (if scarring is suspected)
Accurate diagnosis is crucial, as treatments differ significantly between the two types.
Treatment and Management Options
While non-scarring hair loss often responds well to medical therapy, scarring alopecia focuses on preventing further progression. Dr. Nabatian tailors treatment plans that may include:
Topical and oral medications (e.g., minoxidil, finasteride, doxycycline)
Corticosteroid injections for inflammation control
Platelet-Rich Plasma (PRP) therapy to stimulate regrowth
Laser or light-based therapies for scalp health
Lifestyle and nutritional guidance to support overall hair wellness
When to See a Dermatologist
If you notice sudden shedding, bald patches, scalp pain, or redness, don’t wait. Early intervention can make all the difference in preserving your hair and preventing permanent loss.
Schedule a comprehensive hair loss evaluation with Dr. Adam Nabatian at Premier Dermatology & Aesthetics in Midtown Manhattan. Discover the cause of your hair loss and explore advanced, personalized treatments to restore your scalp and confidence.
