We Are Seeing More Patients With Scarring Alopecia

It is widely accepted among the medical community that the incidence of scarring alopecia has been increasing and we have seen this increase first-hand in our offices.  From 2019 to 2022, the percentage of our new patients that are diagnosed with scarring alopecia has increased from 7.6% to 10.2%.

But let's take one step back... What exactly is Scarring Alopecia?

This is a rare type of hair loss, which is due to inflammation around the hair follicle. Those who have scarring alopecia often have areas with white scales surrounding an area of inflammation, which then leads to scarring in that area. The hair follicles are actually destroyed and disappear.

Symptoms of Scarring Alopecia include:

  • Areas with white scales surrounding an area of inflammation
  • Receding hairline
  • Patches of total loss

This type of hair loss is much more common in women than men, with some studies reporting as high as a 4:1 ratio of women to men.

So why is this increase occurring?

One recent article published in the August 2022 issue of the Journal of the American Academy of Dermatology reviewed 9 studies that evaluated the association between frontal fibrosing alopecia, a type of scarring alopecia, and the use of sunscreens and moisturizers.  What the research found, was that for those participants in the studies, sunscreen use is associated with a 2.21 times higher likelihood of developing frontal fibrosing alopecia and the use of moisturizers is associated with a 2.09 times higher likelihood of developing frontal fibrosing alopecia.

It is still not fully understood why sunscreens or moisturizers could be contributing to scarring alopecia, and more research is required to fully understand the potential cause.  Most likely, it is specific ingredients in some products, combined with a sensitivity to these products in certain individuals. It is important to note that we are not advocating stopping or avoiding the use of sunscreens. We know that sunscreens save lives and provide necessary sun protection, but we do certainly recommend patients refrain from using sunscreen and moisturizers one inch from the hairline and if possible, wear a hat instead of using sunscreen on the scalp.  But if you need to choose between going out with no hat or wearing sunscreen on the scalp, we recommend sunscreen every time.  It is also important to remember that the article is not saying that everyone who uses sunscreen and moisturizes will get frontal fibrosing alopecia. Scarring alopecia is still very rare, even though the incidence is increasing.

So what does this mean for practitioners and patients?

It is important that practitioners that are evaluating women for hair loss understand that there is an increasing incidence of scarring alopecia so that they can be better prepared to diagnose the cause of hair loss.  Scarring alopecia cannot be diagnosed with the naked eye and practitioners need to be trained to perform trichoscopy, which is highly magnified imaging of the scalp to look for signs of scarring alopecia and determine if there is a need to biopsy the scalp to confirm the diagnosis.

It is important for patients to ensure they are being evaluated by practitioners that have the ability to properly diagnose their hair loss.  “Hair loss” is not a diagnosis, and for women, there are many potential causes.  While scarring alopecia is still rare, it is important for all patients experiencing hair loss to be properly evaluated so that they can have the best possible chance to prevent further loss and see regrowth.


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