The surgical treatment of cicatricial alopecia

Abstract

Surgical correction of cicatricial alopecia can yield exceptional results when performed in the appropriate clinical scenario. To facilitate determination of the most suitable corrective therapy, we propose two new categories of cicatricial alopecia: "unstable" and "stable." Unstable cicatricial alopecia is intermittent and results in possible subsequent scarring hair loss in either new or old areas. Stable cicatricial alopecia, on the other hand, refers to fixed permanent scarring. While surgical excision is preferred to hair transplantation for both categories of cicatricial alopecia, this preference is even stronger in cases of unstable cicatricial alopecia due to its intermittent and progressive nature. Regardless of which corrective technique is used, analysis of specific physical patient characteristics coupled with a careful view towards the possible evolution of male pattern baldness or female pattern hair loss are essential to achieve superior long-term results. Herein we also outline guidelines for identifying these physical traits as well as for performing hair transplantation and surgical excision in order to achieve optimal cosmetic outcomes and minimize postoperative complications.

Perda pilosa por líquen plano pilar após transplante capilar: relato de dois casos e revisão da literatura

“…6,9,12 Systemic treatments have been used in cases that do not respond to this initial treatment. 6,9,10 Once the inflammation has been resolved and the alopecia has stabilized, surgical treatment such as scalp reduction or hair transplantation can be considered for these patients 7,10 . There is little information on hair transplantation in patients with LPP in the literature.…”

“…6 Many etiologies can be implicated in this condition, including traumas, such as burns, and congenital, inflammatory and infectious disorders. 4,7 The various etiologies covered by the term cicatricial alopecia can be classified into stable and unstable forms. 7 The latter are characterized by their tendency to progress and recur.…”

“…4,7 The various etiologies covered by the term cicatricial alopecia can be classified into stable and unstable forms. 7 The latter are characterized by their tendency to progress and recur. They include alopecias due to inflammatory causes, 40% of which are accounted for by lichen planopilaris (LPP).…”

Hair Transplantation in the Cicatricial Alopecias

“…Scar tissue formation can occur on the punched out sites, and it is the real limitation factor for that treatment. And higher rates of transection can cause higher possibility of inflammation and cyst formation [4,9].…”

“…Unlike UCA, after succesful correction by surgery, there is no need for the constant vigilance in case of stable cicatricial alopecia. The common causes of SCA include trauma, burns, infection, radiation, and prior surgeries of head and facial areas [4].…”