Hair transplantation for therapy‐resistant alopecia areata of the eyebrows: Is it the right choice?

Abstract

Alopecia areata is a common skin disorder of presumed autoimmune etiology and it usually shows an unpredictable course. Treatment of alopecia areata is challenging. There is very little information on the use of surgical therapies for the treatment of alopecia areata in the medical published work. A 24-year-old male patient was referred to a private hair transplantation clinic owned by one of the authors for the treatment of therapy-resistant alopecia areata affecting both eyebrows. He had quickly lost all body hair 4 years prior beginning from the scalp. He received psoralen and ultraviolet A (PUVA) therapy for alopecia universalis and all body hair re-grew except his eyebrows. Alopecia areata was stable for the 18 months following the last medical treatment he received. Because there was no response to various medical therapeutic agents, we decided to transplant occipital hairs to the eyebrow area. After the patient understood and accepted all risks, occipital hairs were transplanted to the eyebrows by using the follicular unit extraction technique. Postoperatively, the patient did not receive any topical or systemic therapies for alopecia areata. Although 40% hair re-growth was detected in his eyebrows at 1 year postoperation, this rate was 80% by 2 years postoperation. However, there was resistance to re-growth in the medial eyebrow regions. New eyebrows grew as occipital hairs and required trimming. His satisfaction from the surgical procedure was 90% at the end of the 24th postoperative month. Surgical treatment of diseases like alopecia areata is still controversial. Our case report offers an additional contribution to the published work on the surgical methods used in the treatment of stable alopecia areata.

Successful follicular unit extraction in a case of inactive, recalcitrant alopecia barbae

“…4 Civas et al, in 2010, reported HT in AA of eyebrow. 6 They did not give any other oral or topical immunosuppressant to their patient post-FUE. They attribute the sustainability of their grafts to the addition of triamcinolone acetonide during tumescent anesthesia while performing FUE.…”

Resistance of Transplanted Hair Follicles to the Onslaught of Diffuse Alopecia Areata

“…Prior to this, a few reports have described the use of HT to treat stable areas of AA resistant to medical treatment. [2][3][4] Results are mixed but largely report at least initial success. In a report by Barankin et al, 2 a patient with persistent steroid resistant AA over the eyebrow managed to maintain hair growth for 8 months after HT from the scalp.…”

“…Although AA subsequently relapsed, it was now responsive to monthly triamcinolone injections. In another report by Civaş et al, 3 occipital hairs were transplanted into an alopecic area that had been stable for 18 months. The patient did not receive topical or systemic therapies for AA postoperatively, and hair regrowth was 80% by 2 years.…”

Efficacy of superficial cryotherapy on the eyebrows of patients with alopecia universalis also treated with contact immunotherapy on the scalp: a prospective, split‐face comparative study

“…A few treatment modalities are available for treating AA, but none are curative or preventive . Pre‐existing treatment modalities of AA or hair transplantation have been used to treat AA of the eyebrow . In addition, medications known to be effective in eyebrow hypotrichosis, such as 2% minoxidil or bimatoprost, have also been used; however, such treatments have demonstrated unclear efficacy .…”