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!
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.
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.
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