Nonscarring

Nonscarring is a dermatological term used to describe processes that do not cause scarring of the skin or mucosa. In the context of hair loss, nonscarring (noncicatricial) alopecia refers to forms of hair loss in which the hair follicles are preserved and scarring is absent. This distinction is important because it implies potential for regrowth, unlike scarring alopecias in which permanent follicular destruction has occurred.

Pathophysiology and implications: In nonscarring alopecia, hair follicles survive the insult, and hair regrowth is possible once the causal factor is addressed. The course and response to treatment vary by condition, with some forms being transient and others more persistent but still potentially reversible.

Common nonscarring alopecias: The most frequent conditions include androgenetic alopecia (pattern hair loss), telogen effluvium (diffuse shedding often related to stress, illness, or nutritional changes), and alopecia areata (autoimmune patchy hair loss that can show regrowth). Early or mild traction alopecia may also be nonscarring if follicular destruction has not yet occurred. Fungal infections such as tinea capitis can present with patchy nonscarring hair loss as well.

Diagnosis: Evaluation combines history and physical examination with hair-focused tests. Dermoscopy (trichoscopy) can reveal patterns such as follicular openings and hair shaft changes. A hair pull test may indicate active shedding. When diagnosis is uncertain, a scalp biopsy can help distinguish nonscarring from scarring forms by assessing follicle integrity and inflammatory patterns.

Management and prognosis: Treatment targets the underlying cause and may include topical or intralesional corticosteroids for inflammatory conditions, minoxidil for pattern hair loss, or addressing triggers in telogen effluvium. With nonscarring alopecia, many patients experience partial or complete regrowth, especially when treated early; prognosis is generally better than for scarring alopecia, where permanent loss can occur.