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Suggest Treatment For Cicatricial Alopecia When Diagnosed With Interstitial Cystitis And Fibromyalgia
Question: Hi. I am a 42 year old female with scarring alopecia. I have been suffering from this for about 7 years. It started on the right side of my scalp above my right ear. It has slowly progressively gotten worse as it is on the left side now and appears to be accelerating at a more rapid pace now. I did see a dermatologist, (about 4 years ago) had a biopsy and the diagnosis was confirmed. The dermatologist told me there was nothing he can do in terms of treatment.
i am considering (but haven't had a consult) weight loss surgery (the sleeve). From my research, it seems to be inevitable i will lose hair from the surgery although the hair loss is temporary. My question is how likely would it be I would lose my eyelashes and/or eyebrows? I have not lost any so far. Also, if I do lose my hair (including eyelashes and eyebrows) how likely would it be that it would not ever grow back? Would the scarring alopecia complicate the regrowth of the hair process?
I will say my immune system is compromised. i am diabetic. I have also been diagnosed with interstitial cystitis and fibromyalgia, i am anemic and also have a Vitamin D Deficiency but I am taking 50,000 IU per week of D2 to raise the level.
i am considering (but haven't had a consult) weight loss surgery (the sleeve). From my research, it seems to be inevitable i will lose hair from the surgery although the hair loss is temporary. My question is how likely would it be I would lose my eyelashes and/or eyebrows? I have not lost any so far. Also, if I do lose my hair (including eyelashes and eyebrows) how likely would it be that it would not ever grow back? Would the scarring alopecia complicate the regrowth of the hair process?
I will say my immune system is compromised. i am diabetic. I have also been diagnosed with interstitial cystitis and fibromyalgia, i am anemic and also have a Vitamin D Deficiency but I am taking 50,000 IU per week of D2 to raise the level.
Brief Answer:
Weight loss surgery usually does not result in hair loss from eyebrow or ey
Detailed Answer:
Hello. Thank you for writing to us.
I have gone through your query and i understand your concern.
Scaring alopecia of scalp is an end result of inflammatory process which is part of a particular disease involvement of scalp e.g lichen XXXXXXX pilaris, pseudopelade of brocq, discoid lupus erythematosus of scalp are usually associated with scaring alopecia of scalp.
However, scaring process in any of these disease processes involving scalp usually does not involve eyebrows and eyelashes.
As far as weight loss surgery is concerned it is unlikely that it would be followed by loss of eyebrow and/or eyelash hair.
After weight loss surgery most people complain of increased hair shedding from scalp rather than from brows or eyelashes.
As far as scaring alopecia involving your scalp is concerned i would like to know the findings in biopsy report? Was it able to ascertain the actual cause of scaring alopecia? What was the clinical diagnosis suggested by your dermatologist as the reason for this scaring alopecia?
Regards
Weight loss surgery usually does not result in hair loss from eyebrow or ey
Detailed Answer:
Hello. Thank you for writing to us.
I have gone through your query and i understand your concern.
Scaring alopecia of scalp is an end result of inflammatory process which is part of a particular disease involvement of scalp e.g lichen XXXXXXX pilaris, pseudopelade of brocq, discoid lupus erythematosus of scalp are usually associated with scaring alopecia of scalp.
However, scaring process in any of these disease processes involving scalp usually does not involve eyebrows and eyelashes.
As far as weight loss surgery is concerned it is unlikely that it would be followed by loss of eyebrow and/or eyelash hair.
After weight loss surgery most people complain of increased hair shedding from scalp rather than from brows or eyelashes.
As far as scaring alopecia involving your scalp is concerned i would like to know the findings in biopsy report? Was it able to ascertain the actual cause of scaring alopecia? What was the clinical diagnosis suggested by your dermatologist as the reason for this scaring alopecia?
Regards
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
It has been several years since I had the biopsy so I can't recall what the biopsy report said except the finding was cicatricial alopecia. I don't recall the biopsy report mentioning the cause of the alopecia nor did the dermatologist provide any clinical diagnosis and stated there was no treatment options. At first the diagnosis was alopecia areata. I had shots in my scalp for six months and no hair growth was regenerated.
I will say, however, that I NEVER had any inflammation where the hair loss has occurred. They are very smooth and clean bald spots on my scalp. My coworker has the same condition and she was placed on antibiotics because she did have the inflammation.
I have a copy of the report and will let you know what it says but I don't have it with me right now. i will have to write back.
Yes, I am aware weight loss patients only complain of the hair shedding. My friend had significant hair loss though, it came out in handfuls. I just wanted to know if there was a chance the alopecia coupled with the weight loss surgery would increase the chances my eyelashes/eyebrows falling out. Also, if I do lose hair on my head from the surgery, will it grow back? If it grows back, will I have more bald spots due to the alopecia?
This is what the entire biopsy report states:
FINAL DIAGNOSIS:
A. Right scalp, Punch
Scarring Alopecia (704.09)
Comment: The differential diagnosis includes central centrifungal cicatricial alopecia or traction alopecia. Clinical correlation is advised. PAS stain fails to reveal fungal elements.
Source of Specimen: Right scalp, punch
Clinical impression: Scarring vs. areata
GROSS DESCRIPTION:
A. Received in formalin is a pale skin measuring 0.3x 0.3 x 0.6 cm. 2/1.sh
MICROSCOPIC DESCRIPTION:
A. Hair Follicules are decreased in number and replaced by fibrous and fibrotic tracts. There is a mixed inflammatory cell infiltrate consisting of lymphocytes, histiocytes, and a few eosinophils. Sebaceous lobules are decreased in size and number.
**I know this report states there is inflammatory cells but I have never had any inflammation on the scalp.
I will say, however, that I NEVER had any inflammation where the hair loss has occurred. They are very smooth and clean bald spots on my scalp. My coworker has the same condition and she was placed on antibiotics because she did have the inflammation.
I have a copy of the report and will let you know what it says but I don't have it with me right now. i will have to write back.
Yes, I am aware weight loss patients only complain of the hair shedding. My friend had significant hair loss though, it came out in handfuls. I just wanted to know if there was a chance the alopecia coupled with the weight loss surgery would increase the chances my eyelashes/eyebrows falling out. Also, if I do lose hair on my head from the surgery, will it grow back? If it grows back, will I have more bald spots due to the alopecia?
This is what the entire biopsy report states:
FINAL DIAGNOSIS:
A. Right scalp, Punch
Scarring Alopecia (704.09)
Comment: The differential diagnosis includes central centrifungal cicatricial alopecia or traction alopecia. Clinical correlation is advised. PAS stain fails to reveal fungal elements.
Source of Specimen: Right scalp, punch
Clinical impression: Scarring vs. areata
GROSS DESCRIPTION:
A. Received in formalin is a pale skin measuring 0.3x 0.3 x 0.6 cm. 2/1.sh
MICROSCOPIC DESCRIPTION:
A. Hair Follicules are decreased in number and replaced by fibrous and fibrotic tracts. There is a mixed inflammatory cell infiltrate consisting of lymphocytes, histiocytes, and a few eosinophils. Sebaceous lobules are decreased in size and number.
**I know this report states there is inflammatory cells but I have never had any inflammation on the scalp.
Brief Answer:
Surgery may cause increased shedding from scalp but it is reversible
Detailed Answer:
Hi.
I don't see weight loss surgery altering the process of cicatricial alopecia in any way because the reason for hair loss is entirely different with these two.
The only thing is that surgery induced hair loss might make the already existing bald spots more visible, till it recovers.
Increased hair loss after surgery is due to Telogen Effluvium, that is scalp hair gets shifted from growth phase to resting phase and is subsequently shed. Scalp is commonly affected with telogen, not eyebrows or eyelashes.
Telogen effluvium is reversible with time. May take 6-12 months. Telogen is diffuse rather than patchy, unlike cicatricial alopecia.
Moreover, not everyone would have significant shedding (Telogen) post weight loss surgery. It varies with individuals.
Also I don't think the cicatricial process would affect eyebrows or eyelashes Or other body parts. Cicatricial alopecia is usually limited to scalp.
Individuals affected with cicatricial alopeca may have papules and scaling as evidence of inflammation however in most of those affected, inflammation is at a microscopic level. Progression is insidious.
Bald patches due to cicatricial alopecia on scalp won't recover however every effort should be made to halt further progression of cicatricial alopecia with topical and injectable steroids.
Otherwise therpaeutic options are limited in cicatricial alopecia.
Regards
Surgery may cause increased shedding from scalp but it is reversible
Detailed Answer:
Hi.
I don't see weight loss surgery altering the process of cicatricial alopecia in any way because the reason for hair loss is entirely different with these two.
The only thing is that surgery induced hair loss might make the already existing bald spots more visible, till it recovers.
Increased hair loss after surgery is due to Telogen Effluvium, that is scalp hair gets shifted from growth phase to resting phase and is subsequently shed. Scalp is commonly affected with telogen, not eyebrows or eyelashes.
Telogen effluvium is reversible with time. May take 6-12 months. Telogen is diffuse rather than patchy, unlike cicatricial alopecia.
Moreover, not everyone would have significant shedding (Telogen) post weight loss surgery. It varies with individuals.
Also I don't think the cicatricial process would affect eyebrows or eyelashes Or other body parts. Cicatricial alopecia is usually limited to scalp.
Individuals affected with cicatricial alopeca may have papules and scaling as evidence of inflammation however in most of those affected, inflammation is at a microscopic level. Progression is insidious.
Bald patches due to cicatricial alopecia on scalp won't recover however every effort should be made to halt further progression of cicatricial alopecia with topical and injectable steroids.
Otherwise therpaeutic options are limited in cicatricial alopecia.
Regards
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Obviously In not a doctor so I just wanted to know if the biopsy report listed the cause the Cicatricial alopecia because i don't see this. If not, should I follow up with a dermatologist? Would they be able to surmise why this happened?
Brief Answer:
Topical and oral steroids can be tried if it is still progressing
Detailed Answer:
Hi.
Your biopsy report lists the cause of your cicatricial alopecia as either Central centrifugal cicatricial alopecia Or Traction alopecia.
Your dermatologists initially kept the clinical diagnoses of either alopecia areata (which presents as smooth bald patches of REVERSIBLE hair loss) Or scaring alopecia. Subsequent biopsy came out as cicatricial alopecia i.e either central centrifugal cicatricial alopcia or traction alopecia.
Practices like hair braiding, use of hair relaxers etc have been commonly implicated in patients with cicatricial alopecia.
These practices should be avoided in those in whom they seem to be responsible. Most of the cases are however idiopathic.
Central centrifugal cicatricial alopecia is the commonest cause of cicatricial alopecia worldwide.
Course is usually self limiting i.e the disease ultimately stops progressing but not before it leaves behind permanently smooth hairless patches.
Your scalp biopsy report also clearly mentions that hair follicles are replaced by fibrous tracts. It is unlikely that bald patches would regrow new hair, however, topical and oral steroids are indicated if your disease is still active/ expanding to arrest further progression. You may follow up with your dermatologist.
As far as preceding inflammation (prior to scaring) is concerned, it may only be at microscopic level and there may not be any clinically obvious scaling or redness.
Regards
Topical and oral steroids can be tried if it is still progressing
Detailed Answer:
Hi.
Your biopsy report lists the cause of your cicatricial alopecia as either Central centrifugal cicatricial alopecia Or Traction alopecia.
Your dermatologists initially kept the clinical diagnoses of either alopecia areata (which presents as smooth bald patches of REVERSIBLE hair loss) Or scaring alopecia. Subsequent biopsy came out as cicatricial alopecia i.e either central centrifugal cicatricial alopcia or traction alopecia.
Practices like hair braiding, use of hair relaxers etc have been commonly implicated in patients with cicatricial alopecia.
These practices should be avoided in those in whom they seem to be responsible. Most of the cases are however idiopathic.
Central centrifugal cicatricial alopecia is the commonest cause of cicatricial alopecia worldwide.
Course is usually self limiting i.e the disease ultimately stops progressing but not before it leaves behind permanently smooth hairless patches.
Your scalp biopsy report also clearly mentions that hair follicles are replaced by fibrous tracts. It is unlikely that bald patches would regrow new hair, however, topical and oral steroids are indicated if your disease is still active/ expanding to arrest further progression. You may follow up with your dermatologist.
As far as preceding inflammation (prior to scaring) is concerned, it may only be at microscopic level and there may not be any clinically obvious scaling or redness.
Regards
Note: Hope the answers resolves your concerns, however for further guidance of skin related queries consult our Dermatologist.Click here to book a consultation
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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