Scleroderma is usually noticed because of changes in the skin, but when those changes involve the scalp, they can also affect the way hair grows. The important question is not simply how much hair is being lost, but what is happening to the skin and hair follicles underneath.
Key Takeaways
- Scleroderma can affect the scalp and may be associated with localised areas of hair thinning or loss.
- The effect on hair depends on the type of scleroderma and whether the follicle remains intact.
- Scarring around a hair follicle can result in permanent hair loss, whereas not all forms of thinning involve permanent follicle destruction.
- Hair loss in someone with scleroderma may have another cause, so it should not automatically be attributed to the condition.
- Examining both the scalp and the pattern of hair loss can help determine what needs further assessment.
What Happens To A Hair Follicle When The Scalp Changes?
A hair follicle is a living structure within the skin. It needs a healthy surrounding environment to support normal hair growth.
Scleroderma involves changes in connective tissue and can cause skin to become thicker, firmer or tighter. If affected skin is on the scalp, these changes may occur around the hair follicles as well.
The effect is not necessarily the same for everyone. In some people, the main concern may be thinning in an area where the skin has changed. In others, inflammation and subsequent scarring may damage follicles more permanently. This is why the appearance of the scalp can provide information that simply counting shed hairs cannot.
Can Scleroderma Cause Scarring Hair Loss?
It can, particularly when the condition affecting the scalp leads to scarring around the follicles.
A useful distinction is whether a follicle is still present or has been replaced by scar tissue. If the follicle remains intact, hair growth may still be possible, depending on what is causing the hair change. Once a follicle has been permanently destroyed by scarring, however, that particular follicle cannot produce hair normally.
Scalp changes that may warrant assessment include,
- A clearly defined area of reduced hair density
- Skin that feels unusually tight, firm or different from the surrounding scalp
- A patch where the scalp looks visibly different
- Hair loss occurring in the same area as other skin changes
The pattern matters because different causes of hair loss can look quite different.
Is Scleroderma Always The Reason For Hair Loss?
No. Having scleroderma does not mean that every episode of hair shedding or thinning is caused by it.
Hair loss can also occur with hereditary hair loss, nutritional problems, hormonal changes, medications and other scalp or autoimmune conditions. Some people may have more than one factor contributing to their hair changes.
For this reason, it can be unhelpful to assume that scleroderma is responsible without examining the scalp and considering the overall pattern.
What Can A Doctor Learn From Examining The Scalp?
A consultation is not only about looking at how much hair has been lost. The clinician may assess the skin, the distribution of thinning and the appearance of individual hairs and follicles.
Depending on what is found, further assessment may be considered to clarify whether the changes are more consistent with inflammation, scarring or another cause of hair loss.
For someone already diagnosed with scleroderma, telling the doctor when the hair changes began and whether they appeared alongside changes in the skin can also be useful.
Frequently Asked Questions (FAQs)
1. Can scleroderma affect hair growth?
Yes. When scleroderma involves the scalp, changes in the surrounding skin may be associated with hair thinning or loss. The extent and nature of the change can vary.
2. Is hair loss from scleroderma reversible?
It depends on what has happened to the follicle. If the follicle remains intact, regrowth may be possible in some circumstances. Hair loss caused by permanent scarring is different because the affected follicle has been destroyed.
3. Can scalp changes appear before obvious hair loss?
They can. Changes in the skin may be noticeable even when hair density has not changed significantly. New or unusual scalp changes are therefore worth mentioning during a medical consultation.
4. Should I assume that hair loss is caused by my scleroderma?
No. Hair loss has many possible causes. An assessment can help determine whether the scalp changes and hair loss are likely to be related to scleroderma or whether another factor may be involved.
5. When should I have scleroderma-related scalp changes assessed?
Consider seeking medical assessment if you develop a new patch of hair loss, persistent thinning, or noticeable changes in the texture or appearance of the scalp, particularly if these occur in an area affected by scleroderma.
Understanding The Cause Is An Important First Step
When scleroderma affects the scalp, the key question is whether the hair follicles are still intact and what changes are occurring in the surrounding skin. The answer cannot be determined from hair shedding alone.
If you are in Singapore and have persistent or unexplained hair loss alongside scalp or skin changes, you may wish to discuss them with Dr Ang Chee Beng at Ang Skin & Hair Clinic. A consultation can help assess the pattern of hair and scalp changes and determine whether further evaluation is appropriate.
Consider booking a consultation with Ang Skin & Hair Clinic if you are concerned about persistent or unexplained scalp and hair changes.