Cicatricial alopecia, also termed as scarring alopecia indicates a set of abnormalities, which destroys hair follicles thereby causing baldness. The affected follicles get replaced by the scar tissue that resulting hair loss permanently. Cicatricial alopecia can occur among any group of healthy women and can be treated with surgical hair transplant. In this procedure, hair follicles are removed from the “donor site”and implanted to the balding part termed as the “recipient site”. The cicatricial alopecia patient can gain back her lost hair through this and have a renewed sense of confidence and well being. We recently operated upon a patient suffering from Cicatricial Alpecia second time and would like to share her case with all of you.
A 36 yr old female presented with the chief complaint of hair loss over scalp since 11 years. She noticed patchy hair loss on the scalp right after the first childbirth. However, it was associated with no other symptoms. The patient took multiple treatments outside but did not get any relief. On examination of scalp; there was a big patch of hair loss of around 10* 12 cm over central part of scalp sparring fringes in the front. Skin showed atrophy and wrinkling with shiny appearance. Biopsy revealed cictricial alopecia with possibility of lichen planopilaris.
Pic. Of before surgery……
The patient was first treated with oral medicines and local injections to which she responded. Patient seemed to show improvement in terms of no further hair loss and some areas also showed hair re-growth in the periphery. After inactivity of the disease was established for 1 year and improvement was noticed, we did a Trial hair Transplant of 100 grafts by FUE technique.
Pic. Of trial HT…….
She showed excellent results with seen approx. 80% re-growth in 6 months. The patient was encouraged by the results and we decided to go ahead with 1000 grafts by FUE. The plan was to cover the most prominent area.
Pic of after 1st surgery…
Again the result was excellent and re-growth robust.
Pic of result after2nd surgery…….
Encouraged by good results, 1 year later patient came for full area coverage and need for more grafts. 1500 grafts were given this time as donor did not seem to support more. Patient is very happy with the surgery and a satisfied being.
Understanding Cicatricial alopecia
Cicatricial alopecia is a disease which causes a gradual loss of hair, sometimes without giving out any visible symptoms. There are times when the patient will have hair loss followed with burning sensations, sharp pains and extreme itching. The inflammation affects and obliterates the hair follicle below the skin texture and generally no scar is visible on the scalp. The affected areas of the scalp might appear red, have scaling, and appear inflamed. Other signs may include decreased pigmentation, pustules, or draining sinuses.
Possible causes of Cicatricial alopecia in women
There can be many causes of Cicatricial alopecia. However the most plausible cause involves inflammation that takes place at the upper part of the hair follicle. It is usually noticed more in women of African descent but can also affect others. Other causes include psychological stress, nutritional deficiency, exposed to strong medication such as chemotherapy, presence of dermatophyte fungus in the scalp, childbirth (postpartum alopecia)and deep trauma.
Types of Cicatricial Alopecia
There are two types of Cicatricial alopecia, primary and secondary.
- Primary cicatricial alopecia is when the sebaceous gland unit of the hair follicle is the main target of the severe inflammatory process.
- Sceondary cicatricial alopecia in which the hair follicle damage is subsidiary to any external injury or any non-follicle-directed process.
Role of Hair Transplant as a treatment modality
The plan for such a patient should include a Biopsy to establish the activity of the disease. If it is inactive for more than one year, then the patient may undergo hair transplant as we did in this patient..If the hair transplant surgeon is unsure, then he can do a Trial Hair transplant i.e. implant around 100 grafts and see how many of the hair grow up. If the results are positive, then she may undergo complete hair transplant or may even directly undergo hair transplant. The main difference in this category of patients is that the donor area may also be affected by Cicatricial Alopecia. This may lead to less number of grafts available for extraction. The density of implantation should be less than routine and avoid dense packing. The session should be carried out in more time than usual. The amount of adrenaline used for hemostasis should be less. And also, these grafts may not grow because of the underlying inflammation. And there are chances of follicular cicatricial alopecia recurring post a surgical treatmentwhich should be explained to the patient.