Information and Solutions for Men and Women

Types and Causes of Permanent Hair Loss

What are the types and causes of permanent hair loss?

Cicatricial alopecia is often permanent because hair follicles are destroyed—in particular, the stem cells that give the follicle its ability to regenerate. 24 Although it is considered the scarring form of hair loss, this does not refer to visible scars on the scalp but rather to the scar tissue that replaces the normal hair follicle cells beneath the surface.2 Although cicatricial hair loss can resemble alopecia areata, close examination of the scalp will show that it is smooth, without any follicle openings.180


Primary cicatricial alopecias are rare inflammatory scalp disorders where hair follicles, normally immune-privileged and not affected by the immune system, are instead targeted by lymphocytes and neutrophils. These inflammatory immune system white blood cells are meant to protect the body against foreign substances (e.g., viruses and bacteria). In primary cicatricial alopecias they turn against the body's own follicle cells, destroying and replacing them with scar tissue, indicating that these cicatricial conditions are essentially autoimmune disorders. 13, 124, 125

In fact, primary cicatricial alopecias are categorized by the type of immune cell that targets, infiltrates, and destroys the hair follicle in each condition: 24, 181

Table 35: Primary Cicatricial Alopecias by Category
Alopecia Mucinosa
Chronic Cutaneous (Discoid) Lupus Erythematosus
Folliculitis Decalvans
Keratosis Follicularis Spinulosa Decalvans
Lichen Planus (all types)

Secondary cicatricial alopecias are caused by conditions, diseases, or trauma that may cause permanent, irreversible hair follicle destruction and hair loss but do not specifically target the hair follicle. These include: 24

  • Cancer
  • Infections (bacterial, fungal, and viral)
  • Inflammatory auto immune diseases (e.g., scleroderma)
  • Physical trauma (e.g., radiation and burns)

Although hair cannot (with current medical technology) be regrown, cicatricial alopecia can be treated to stop it from progressing and to relieve symptoms.24

Given the importance of hair to our self-confidence and psychological well-being, it is critical to understand the cosmetic options available to those men and women suffering from cicatricial alopecia. These include an array of products to make the hair they do have appear thicker or wigs and hairpieces. It is even possible to replace lost hair surgically in some cases.

Disclaimer: This website is not intended to replace professional consultation, diagnosis, or treatment by a licensed physician. If you require any medical related advice, contact your physician promptly. Information presented on this website is exclusively of a general reference nature. Do not disregard medical advice or delay treatment as a result of accessing information at this site.
Although earlier texts refer to alopecia mucinosa as a secondary cicatricial alopecia and do not categorize it by immune infiltrate type, later texts identify it as lymphocytic.
Such as burning sensation, itching, and pain.