Scarring Alopecia & Hair Loss Treatment in London – Consultant Dermatologist
Scarring hair loss (cicatricial alopecia) is a group of conditions where inflammation damages the hair follicle’s stem‑cell environment. The priority is to halt progression and relieve symptoms (itch, pain, burning), preserving remaining hair. Our consultant‑led clinic combines precise diagnosis—trichoscopy and, where appropriate, scalp biopsy—with targeted medical therapy, selective light‑based treatments, regenerative adjuncts, and supportive scalp care delivered in a CQC‑regulated setting.
Introduction
Scarring alopecias include lichen planopilaris (LPP) and its frontal variant (FFA), discoid lupus erythematosus of the scalp, central centrifugal cicatricial alopecia (CCCA) and others. Unlike non‑scarring conditions such as alopecia areata or telogen effluvium, scarring diseases can permanently replace follicles with scar tissue if untreated. Early recognition and a structured plan help to stabilise activity and protect remaining density. At Skinhorizon, your pathway is consultant‑delivered with clear milestones, written instructions and close follow‑up.
Get expert help to diagnose, stabilise and manage scarring hair loss in a medically supervised setting.
What is Scarring Hair Loss?
“Scarring” (cicatricial) hair loss describes conditions where chronic inflammation damages hair follicles, particularly their stem‑cell niches, leading to permanent loss in affected areas. Typical symptoms include itch, burning, tenderness and visible signs such as perifollicular redness/scale, broken hairs, or smooth, shiny patches lacking follicular openings in advanced sites. Common subtypes are lichen planopilaris (LPP) and frontal fibrosing alopecia (FFA), discoid lupus erythematosus of the scalp, and central centrifugal cicatricial alopecia (CCCA). Distinguishing scarring from non‑scarring disorders—like telogen effluvium shedding or alopecia areata—is crucial because management goals differ.
Scalp health issues such as psoriasis of the scalp or seborrhoeic dermatitis may co‑exist and aggravate symptoms. A precise diagnosis underpins realistic expectations: in scarring alopecia the aim is to stop the fire (inflammation) and preserve what you have, while supporting hair and scalp comfort.
Diagnosis & Assessment at Skinhorizon
- Consultant history: onset and tempo, itch/pain/burning, hairstyles or traction, chemical or heat exposure, autoimmune history, medications and life events.
- Examination: pattern mapping (frontal banding, vertex, crown), perifollicular scale/erythema, loss of follicular openings, pull test, tender areas.
- Trichoscopy: high‑magnification evaluation of follicles and scalp clues (peripilar casts, broken hairs, absence of ostia) to differentiate scarring vs non‑scarring causes.
- Targeted blood tests: thyroid profile, ferritin/iron studies, vitamin D; selected autoimmune screening when indicated.
- Scalp biopsy (if indicated): a small punch biopsy from an active margin can confirm type and stage, guiding the medical plan.
- Photography & tracking: standardised angles/lighting and fixed trichoscopic sites to monitor activity and stability over time.
Personalised Treatment Options We Offer
Scalp Analysis & Biopsy (where indicated)
Accurate diagnosis is the foundation of success. We perform consultant‑delivered trichoscopy to visualise follicles and perifollicular signs, identify activity at the disease edge, and rule out mimics. Where necessary, a small scalp biopsy from an active margin confirms the diagnosis and disease stage. Biopsy can be especially helpful when features overlap between LPP/FFA, discoid lupus or other cicatricial alopecias. Clear classification allows us to choose the least‑burdensome, most effective plan.
Blood Tests (safety & contributing factors)
Bloods are tailored to your history. We commonly check thyroid function, ferritin/iron studies and vitamin D, and consider autoimmune screening if symptoms or family history suggest broader immune involvement. Results help personalise care and ensure the safe use of medical therapies.
Steroid Injections (Intralesional) for Active Margins
Intralesional corticosteroid injections damp down active perifollicular inflammation at the disease border (where redness, scale and tenderness often cluster). Sessions are brief and spaced several weeks apart, with dosing adjusted to response and site sensitivity. Patients frequently report symptom relief (itch, pain) and reduced expansion of the affected area. We dose‑limit to minimise risks such as local skin thinning or pigment change.
- Targeted to symptomatic, active borders.
- Used as part of a broader plan (topical/systemic therapy, scalp care, trigger control).
- Quick appointments, minimal downtime.
Topical & Systemic Immunomodulators (consultant‑guided)
Depending on your subtype and severity, we may recommend topical anti‑inflammatories (e.g., steroid lotions or steroid‑sparing agents) and—in appropriate cases—systemic therapies to calm disease activity. Systemic options are selected and monitored by your consultant; we discuss benefits, safety and alternatives in plain language and coordinate any required baseline and follow‑up tests. The goal is to achieve and maintain stability while minimising treatment burden.
Excimer UVB Phototherapy (308 nm, selected cases)
Targeted 308 nm Excimer phototherapy delivers precise medical UVB to areas of activity, helping to modulate local immune responses while limiting exposure to surrounding scalp. We use it selectively where clinical signs and sensitivity suggest potential benefit, often alongside intralesional therapy and a supportive routine. Sessions are short, repeated 1–2×/week in a course, with protective eyewear and careful dose escalation.
Exosome Therapy (Regenerative Adjunct)
Exosomes are nano‑sized vesicles rich in signalling molecules that may support a healthier micro‑environment for remaining follicles. In scarring alopecia they are not a cure for scarring, but can be considered as an adjunct once inflammation is controlled, to support hair quality in preserved areas. We typically pair exosomes with micro‑channeling for delivery and track changes with photography and trichoscopy.
Supportive Hair & Scalp Care Routine
Gentle, consistent care reduces symptom burden and protects fragile areas. We advise on soap‑free cleansers, avoiding tight styles and hot tools, and minimising friction or trauma to active borders. Our clinic stocks supportive options such as DP Exo‑Grow All‑in‑One Shampoo; we tailor a minimal routine that fits your life. Patch‑test new products for 24 hours behind the ear or on an inconspicuous area before full use.
Your Care Journey
- Confirm the diagnosis: consultant review, trichoscopy and targeted bloods; biopsy from an active margin if needed.
- Stabilise activity: intralesional steroids to symptomatic borders; topical anti‑inflammatories and, when indicated, systemic options.
- Selective adjuncts: targeted 308 nm Excimer phototherapy and/or exosome therapy when appropriate.
- Scalp care plan: friction/heat reduction, gentle cleansing, avoidance of tight styles; written instructions for home.
- Review & refine: follow‑ups every 6–12 weeks initially; track symptoms, photographs and trichoscopic markers to judge stability.
Success is measured by stability (no expansion, fewer symptoms). Where follicles are preserved, cosmetic fullness may improve with supportive care over time.
Special Situations
- Frontal fibrosing alopecia (FFA): typically band‑like recession with eyebrow involvement; sunscreen selection and cosmetic camouflage are discussed alongside medical care.
- Discoid lupus of the scalp: photosensitivity counselling and protective strategies are emphasised; we coordinate wider lupus screening where indicated.
- CCCA and hair practices: address traction, heat and chemical relaxers; protective styling guidance to reduce ongoing injury.
- Overlap with non‑scarring shedding: distinguish concurrent telogen effluvium to set expectations around temporary increased fall during stabilisation.
- Menopause & hormonal change: symptom onset can cluster around hormonal transitions; we plan for long‑term maintenance and lifestyle support.
Aftercare & Maintenance
Follow your written plan closely: avoid tight styles, heavy traction and harsh chemicals; use recommended cleansers; protect the scalp from sunburn; and report new itch, pain or tingling promptly. Maintenance strategies may include occasional intralesional top‑ups in truly active sites, periodic reviews, and supportive measures (e.g., LED for comfort if helpful, exosome top‑ups in preserved zones). We’ll show you how to part hair and photograph the same areas at home to spot change early.
Safety & Risks
We choose the least‑burdensome effective plan. Intralesional steroids can, if over‑treated, cause local skin thinning or pigment change; we dose‑limit and space sessions appropriately. Topical and systemic medicines require screening and monitoring—benefits, risks and alternatives are discussed in detail before treatment. Excimer phototherapy may cause temporary redness or dryness; eye protection and careful dose escalation are standard. Exosome therapy is used as an adjunct; we assess suitability individually and avoid over‑promising results.
Expected Outcomes
In scarring alopecia, the primary success measure is stabilisation: reduced symptoms (itch, pain, burning), no further expansion, and calmer trichoscopic signs at previously active borders. Where follicles are preserved, some improvement in cosmetic fullness can occur with supportive routines and adjunctive therapies, but destroyed follicles do not regrow. Our goal is to protect what you have, restore comfort and confidence, and provide long‑term support with realistic milestones.
Patient Experience
“The burning across my hairline settled within weeks, and the photographs showed no further creeping. Having a clear plan and regular reviews made all the difference.”
— Verified Skinhorizon scarring hair loss patient
Why Choose Skinhorizon for Scarring Hair Loss?
- Consultant‑led diagnosis: precise classification with trichoscopy and biopsy when needed—no guesswork.
- Targeted therapies on‑site: intralesional steroids, selective 308 nm Excimer phototherapy and supportive adjuncts.
- Clear written plans: step‑by‑step instructions, trigger control, and realistic timelines for stabilisation.
- CQC‑regulated care: robust governance, monitoring and documentation for safety.
- Holistic support: scalp‑friendly routines, camouflage options and practical coaching for day‑to‑day confidence.
Book Your Consultation
Get expert, consultant‑led care to stabilise scarring hair loss and protect remaining density.
Frequently Asked Questions
Can scarring hair loss be reversed?
How do you confirm the diagnosis?
Are steroid injections painful?
Is phototherapy helpful in scarring alopecia?
Do exosomes regrow scarred areas?
This page was reviewed by Dr Mohammad Ghazavi, Consultant Dermatologist, last updated August 2025.
Disclaimer: The information on this page is provided for general educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Individual results vary, and all medical and aesthetic procedures carry risks and potential complications which will be fully discussed during your consultation. Suitability for treatment can only be determined following an in-person assessment with a qualified healthcare professional at Skinhorizon Clinic.
