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CC BY-NC-ND 4.0 · Indian J Plast Surg 2021; 54(04): 501-506
DOI: 10.1055/s-0041-1739246
Review Article

Role of Hair Transplantation in Scarring Alopecia—To Do or Not to Do

Sukhbir Singh
1   Department of Plastic Surgery, Resplendent the Cosmetic Studio, New Delhi, India
,
Kumaresan Muthuvel
2   Department of Dermatology, Cutis Skin Clinic and Hair Transplant Centre, Coimbatore, Tamil Nadu, India
› Author Affiliations Financial Disclosures None.
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Abstract

Alopecia in the scalp region leads to psychosocial embarrassment for an individual. Alopecia could be due to several reasons, including genetic, hormonal, traumatic and infections. Cicatricial alopecias (CAs) are considered as trichological emergency, since their progression is rapid and always results in permanent hair loss. The pathogenesis, disease progression and prognosis of CA are poorly understood, and the treatment process is still evolving. An early diagnosis must be established, and aggressive treatment protocol should be followed in the management of scarring alopecia. This article presents various aspects of CA and determines whether hair transplant (HT) should be done in this condition.

Keywords

cicatricial alopecia (CA) - hair transplant - hair follicle - frontal fibrosing alopecia (FFA) - central centrifugal cicatricial alopecia (CCCA)


Publication History

Article published online:
27 December 2021

© 2021. Association of Plastic Surgeons of India. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Whiting DA. Cicatricial alopecia: clinico-pathological findings and treatment. Clin Dermatol 2001; 19 (02) 211-225
    CrossrefPubMedGoogle Scholar
  • 2 Tan E, Martinka M, Ball N, Shapiro J. Primary cicatricial alopecias: clinicopathology of 112 cases. J Am Acad Dermatol 2004; 50 (01) 25-32
    CrossrefPubMedGoogle Scholar
  • 3 Griffin LL, Michaelides C, Griffiths CE, Paus R, Harries MJ. Primary cicatricial alopecias: a U.K. survey. Br J Dermatol 2012; 167 (03) 694-697
    CrossrefPubMedGoogle Scholar
  • 4 Ohyama M. Primary cicatricial alopecia: recent advances in understanding and management. J Dermatol 2012; 39 (01) 18-26
    CrossrefPubMedGoogle Scholar
  • 5 Paus R, Olsen E, Messenger A. Hair growth disorders. In: Wolff K, Goldsmith LA, Katz SI, Gilchrest BA, Paller AS, Leffell DJ. eds. Fitzpatrick's Dermatology in General Medicine. 7th ed.. New York: McGraw-Hill; 2008: 753
    Google Scholar
  • 6 Sinclair RD. Acquired cicatricial alopecia. In: Burns T, Breathnach SM, Cox N, Griffiths CE. eds. Rook's Textbook of Dermatology. 8th ed.. Oxford: Wiley-Blackwill Publishing; 2010: 66.38-66.52
    Google Scholar
  • 7 Rongioletti F, Christana K. Cicatricial (scarring) alopecias: an overview of pathogenesis, classification, diagnosis, and treatment. Am J Clin Dermatol 2012; 13 (04) 247-260
    CrossrefPubMedGoogle Scholar
  • 8 Unger W, Unger R, Wesley C. The surgical treatment of cicatricial alopecia. Dermatol Ther 2008; 21 (04) 295-311
    CrossrefPubMedGoogle Scholar
  • 9 Sellheyer K, Bergfeld WF. Histopathologic evaluation of alopecias. Am J Dermatopathol 2006; 28 (03) 236-259
    CrossrefPubMedGoogle Scholar
  • 10 Lavker RM, Sun TT, Oshima H. et al. Hair follicle stem cells. J Investig Dermatol Symp Proc 2003; 8 (01) 28-38
    CrossrefPubMedGoogle Scholar
  • 11 Harries MJ, Paus R. The pathogenesis of primary cicatricial alopecias. Am J Pathol 2010; 177 (05) 2152-2162
    CrossrefPubMedGoogle Scholar
  • 12 Cotsarelis G. Epithelial stem cells: a folliculocentric view. J Invest Dermatol 2006; 126 (07) 1459-1468
    CrossrefPubMedGoogle Scholar
  • 13 Paus R, Cotsarelis G. The biology of hair follicles. N Engl J Med 1999; 341 (07) 491-497
    CrossrefPubMedGoogle Scholar
  • 14 Pozdnyakova O, Mahalingam M. Involvement of the bulge region in primary scarring alopecia. J Cutan Pathol 2008; 35 (10) 922-925
    CrossrefPubMedGoogle Scholar
  • 15 Al-Refu K, Edward S, Ingham E, Goodfield M. Expression of hair follicle stem cells detected by cytokeratin 15 stain: implications for pathogenesis of the scarring process in cutaneous lupus erythematosus. Br J Dermatol 2009; 160 (06) 1188-1196
    CrossrefPubMedGoogle Scholar
  • 16 Cotsarelis G, Millar SE. Towards a molecular understanding of hair loss and its treatment. Trends Mol Med 2001; 7 (07) 293-301
    CrossrefPubMedGoogle Scholar
  • 17 McElwee KJ. Etiology of cicatricial alopecias: a basic science point of view. Dermatol Ther 2008; 21 (04) 212-220
    CrossrefPubMedGoogle Scholar
  • 18 Nijhof JG, Braun KM, Giangreco A. et al. The cell-surface marker MTS24 identifies a novel population of follicular keratinocytes with characteristics of progenitor cells. Development 2006; 133 (15) 3027-3037
    CrossrefPubMedGoogle Scholar
  • 19 Jensen KB, Collins CA, Nascimento E. et al. Lrig1 expression defines a distinct multipotent stem cell population in mammalian epidermis. Cell Stem Cell 2009; 4 (05) 427-439
    CrossrefPubMedGoogle Scholar
  • 20 Amoh Y, Li L, Katsuoka K, Penman S, Hoffman RM. Multipotent nestin-positive, keratin-negative hair-follicle bulge stem cells can form neurons. Proc Natl Acad Sci U S A 2005; 102 (15) 5530-5534
    CrossrefPubMedGoogle Scholar
  • 21 Jaks V, Barker N, Kasper M. et al. Lgr5 marks cycling, yet long-lived, hair follicle stem cells. Nat Genet 2008; 40 (11) 1291-1299
    CrossrefPubMedGoogle Scholar
  • 22 Snippert HJ, Haegebarth A, Kasper M. et al. Lgr6 marks stem cells in the hair follicle that generate all cell lineages of the skin. Science 2010; 327 (5971): 1385-1389
    CrossrefPubMedGoogle Scholar
  • 23 Harries MJ, Meyer KC, Chaudhry IH, Griffiths CE, Paus R. Does collapse of immune privilege in the hair-follicle bulge play a role in the pathogenesis of primary cicatricial alopecia?. Clin Exp Dermatol 2010; 35 (06) 637-644
    CrossrefPubMedGoogle Scholar
  • 24 Baima B, Sticherling M. Apoptosis in different cutaneous manifestations of lupus erythematosus. Br J Dermatol 2001; 144 (05) 958-966
    CrossrefPubMedGoogle Scholar
  • 25 Pablos JL, Santiago B, Galindo M, Carreira PE, Ballestin C, Gomez-Reino JJ. Keratinocyte apoptosis and p53 expression in cutaneous lupus and dermatomyositis. J Pathol 1999; 188 (01) 63-68
    CrossrefPubMedGoogle Scholar
  • 26 Nakajima M, Nakajima A, Kayagaki N, Honda M, Yagita H, Okumura K. Expression of Fas ligand and its receptor in cutaneous lupus: implication in tissue injury. Clin Immunol Immunopathol 1997; 83 (03) 223-229
    CrossrefPubMedGoogle Scholar
  • 27 Zheng Y, Eilertsen KJ, Ge L. et al. Scd1 is expressed in sebaceous glands and is disrupted in the asebia mouse. Nat Genet 1999; 23 (03) 268-270
    CrossrefPubMedGoogle Scholar
  • 28 Sundberg JP, Boggess D, Sundberg BA. et al. Asebia-2J (Scd1(ab2J)): a new allele and a model for scarring alopecia. Am J Pathol 2000; 156 (06) 2067-2075
    CrossrefPubMedGoogle Scholar
  • 29 Stenn KS. Insights from the asebia mouse: a molecular sebaceous gland defect leading to cicatricial alopecia. J Cutan Pathol 2001; 28 (09) 445-447
    CrossrefPubMedGoogle Scholar
  • 30 Karnik P, Tekeste Z, McCormick TS. et al. Hair follicle stem cell-specific PPARgamma deletion causes scarring alopecia. J Invest Dermatol 2009; 129 (05) 1243-1257
    CrossrefPubMedGoogle Scholar
  • 31 Gho CG, Neumann HA. Improved hair restoration method for burns. Burns 2011; 37 (03) 427-433
    CrossrefPubMedGoogle Scholar
  • 32 Orentreich N. Autografts in alopecias and other selected dermatological conditions. Ann N Y Acad Sci 1959; 83: 463-479
    CrossrefPubMedGoogle Scholar
  • 33 Limmer BL. Elliptical donor stereoscopically assisted micrografting as an approach to further refinement in hair transplantation. J Dermatol Surg Oncol 1994; 20 (12) 789-793
    CrossrefPubMedGoogle Scholar
  • 34 Rassman WR, Carson S. Micrografting in extensive quantities. The ideal hair restoration procedure. Dermatol Surg 1995; 21 (04) 306-311
    CrossrefPubMedGoogle Scholar
  • 35 Bernstein RM, Rassman WR. Follicular transplantation. Patient evaluation and surgical planning. Dermatol Surg 1997; 23 (09) 771-784 , discussion 801–805
    CrossrefPubMedGoogle Scholar
  • 36 Sperling LC, Sau P. The follicular degeneration syndrome in black patients. 'Hot comb alopecia' revisited and revised. Arch Dermatol 1992; 128 (01) 68-74
    CrossrefPubMedGoogle Scholar
  • 37 Filbrandt R, Rufaut N, Jones L, Sinclair R. Primary cicatricial alopecia: diagnosis and treatment. CMAJ 2013; 185 (18) 1579-1585
    CrossrefPubMedGoogle Scholar
  • 38 Shapiro J. Cicatricial alopecias. Dermatol Ther 2008; 21 (04) 211
    CrossrefPubMedGoogle Scholar
  • 39 Harries M, Trueb RM, Tosti A. et al. How not to get scar(r)ed: pointers to the correct diagnosis in patients with suspected primary cicatricial alopecia. Br J Dermatol 2009; 160: 482-501
    CrossrefPubMedGoogle Scholar
  • 40 Harries MJ, Sinclair RD, Macdonald-Hull S, Whiting DA, Griffiths CE, Paus R. Management of primary cicatricial alopecias: options for treatment. Br J Dermatol 2008; 159 (01) 1-22
    CrossrefPubMedGoogle Scholar
  • 41 Ekelem C, Pham C, Atanaskova Mesinkovska N. A systematic review of the outcome of hair transplantation in primary scarring alopecia. Skin Appendage Disord 2019; 5 (02) 65-71
    CrossrefPubMedGoogle Scholar
  • 42 Yang CC. Calvitron automated hair transplant system in alopecia treatment: a case report. Kaohsiung J Med Sci 2003; 19 (09) 470-475
    CrossrefPubMedGoogle Scholar
  • 43 Shiell RC. Modern hair restoration surgery. Clin Dermatol 2001; 19 (02) 179-187
    CrossrefPubMedGoogle Scholar
  • 44 Umar S. Hair transplantation in patients with inadequate head donor supply using non-head hair: report of 3 cases. Ann Plast Surg 2011; 67 (04) 332-5
    CrossrefPubMedGoogle Scholar
  • 45 Shao H, Hang H, Yunyun J. et al. Follicular unit transplantation for the treatment of secondary cicatricial alopecia. Plast Surg (Oakv) 2014; 22 (04) 249-253
    CrossrefPubMedGoogle Scholar
  • 46 Sattur SS. A review of surgical methods (excluding hair transplantation) and their role in hair loss management today. J Cutan Aesthet Surg 2011; 4 (02) 89-97
    CrossrefPubMedGoogle Scholar
  • 47 Unger MG, Unger WP. Management of alopecia of the scalp by a combination of excisions and transplantations. J Dermatol Surg Oncol 1978; 4 (09) 670-672
    CrossrefPubMedGoogle Scholar
  • 48 Cooley J. Complications of hair transplantation. In: Unger WP, Shapiro R. eds. Hair Transplantation, 4th ed. New York: Marcel Dekker; 2004: 573
    Google Scholar
  • 49 Madura C, Vinay N, Kusuma MR, Harsha S, Chandrashekar BS. The assessment of hair transplantation outcomes in cicatricial alopecia. Int J Trichology 2020; 12 (04) 164-167
    CrossrefPubMedGoogle Scholar
  • 50 Kutlubay Z, Kucuktas M, Engin B. Hair transplantation in the cicatricial alopecias. Hair Ther Transplant 2013; 3: 1-4
    Google Scholar
  • 51 Kwon OS, Kim MH, Park SH, Chung JH, Eun HC, Oh JK. Staged hair transplantation in cicatricial alopecia after carbon dioxide laser-assisted scar tissue remodeling. Arch Dermatol 2007; 143 (04) 457-460
    CrossrefPubMedGoogle Scholar
  • 52 Kumar AR, Ishii LE. Hair transplantation for scarring alopecia. Facial Plast Surg Clin North Am 2020; 28 (02) 177-179
    CrossrefPubMedGoogle Scholar