Scarring alopecia is a heterogeneous group of rare disorders characterized by permanent destruction of hair follicles resulting in scarring and permanent, irreversible hair loss. It has been estimated that primary scarring alopecias account for 3% of the total number of alopecia, and they are divided into primary and secondary scarring alopecia. This paper emphasizes primary scarring alopecias, which are classified according to the type of dominant inflammatory infiltrate determined by pathohistological analysis of biopsies of the affected part of the scalp. This classification divides primary scarring alopecias into lymphocytic, neutrophilic, mixed, and nonspecific. Lymphocytic alopecia is the largest group of primary scarring alopecia characterized by predominantly lymphocytic infiltrate, and among them, we distinguish several main clinical entities: chronic cutaneous lupus erythematosus, lichen planopilaris, frontal fibrosing alopecia, Graham-Little syndrome, alopecia mucinosa, keratosis follicularis spinulosa decalvans and, as a new entity, fibrosing alopecia in a pattern of distribution. Neutrophilic primary scarring alopecia is characterized by a predominantly neutrophilic infiltrate, and folliculitis decalvans and dissecting scalp folliculitis belong to this group. Less common primary scarring alopecias include mixed (acne keloidalis, acne necrotica, and erosive pustular dermatosis of the scalp) and nonspecific (tinea capitis). Treatment of these diseases is based on reducing inflammation if present (intralesional and local corticosteroids, antibiotics) and modulating the immune response (retinoids, antimalarials, calcineurin inhibitors). Of course, each clinical entity listed in the paper requires a specific therapy that is described in detail.