Hair Loss

Is scalp redness always a bad sign? — Donovan Hair Clinic

Scalp Redness in Scarring Alopecia … Not Always a Sign of Disease Activity.

Let’s talk about some of the myths pertaining to the topic of scalp redness. To start off, red scalp is not normal. For patients with scarring alopecia, a red scalp is often a sign of disease activity. the image below shows a patient with active scarring alopecia and significant redness. However, one must be careful about concluding it’s always an indicator of disease activity. It’s not always!

Scalp redness in a patient with scarring alopecia (lichen planopilaris). For many patients with scarring alopecia (but not all), scalp redness indicates that disease activity is still high.

Scalp redness in a patient with scarring alopecia (lichen planopilaris). For many patients with scarring alopecia (but not all), scalp redness indicates that disease activity is still high.

Scalp redness in a patient with scarring alopecia. Here, scalp redness is due to dilated blood vessels or ‘telangiectasis’ rather than high disease activity. This patient was using more and more topical steroids to combat the redness and this only worsened the problem. Reducing steroids was the strategy to overcome the telangiectasias.

Scalp redness in a patient with scarring alopecia. Here, scalp redness is due to dilated blood vessels or ‘telangiectasis’ rather than high disease activity. This patient was using more and more topical steroids to combat the redness and this only worsened the problem. Reducing steroids was the strategy to overcome the telangiectasias.

Contact dermatitis is also on the list of possibilities- especially irritant contact dermatitis. Shampoos, minoxidil, compounded formulas, serums all have the potential to irritate.

Finally some scarring alopecias just remain red. Year after year, the redness stays around despite the fact that symptoms have long gone and hair loss has long stopped. I call this post scarring alopecia persistent erythema (PSAPE). Erythema means redness.

redness

In conclusion, redness is a usually a concern in patients with scarring alopecia. Although it is usually a sign that the scarring alopecia is active, it is not always. Other causes must be considered. In some cases of redness, like corticosteroid-induced telangiectasias, treatment might actually need to be reduced rather than increased.


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss.
To schedule a consultation, please call the Whistler office at 604.283.1887


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You can follow a few hair hygiene tips to make your hair less likely to fall out: Avoid hairstyles that pull on the hair - Avoid high-heat hair styling tools - Don't chemically treat or bleach your hair - Use a shampoo that's mild and suited for your hair - Use a soft brush made from natural fibers - Try low-level light therapy.

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