Scalp hairs complete the body self-image and patients with alopecia suffer from overt disfiguration, leading to psychosocial embarrassment and significant lack of self-esteem. Hence an early diagnosis and an aggressive treatment in the case of active hair loss are crucial in the management of scarring alopecia. This review presents a comprehensive study of newer theories in aetiopathogenesis, evolving diagnostic modalities and a step ladder approach in management of primary cicatricial alopecia.