Scarring Alopecia

mj2323

I was wondering if you have ever done a procedure on someone with scarring alopecia? I was recently diagnosed with scarring alopecia however it is considered end stage with no active inflammation.

drcole

Yes, it is possible to perform a transplant on scarring alopecia. it is very important, however for the scarring alopecia to be burned out. in other words, it should not have gotten worse for the past two years. if the scarring alopecia has stayed stable for 2 years with no progression, then you can safely say it has burned itself out and you can safely graft it. There are many different types of scarring alopecia. what is your diagnosis. i assume you have had a biopsy in the past.

mj2323

Dr Cole,
Thanks for the response. Yes, I have had a scalp biopsy. The diagnosis was end stage scarring alopecia, specifically"Pseudopelade would have to be considered histologically". I'm 31 years old and have been losing my hair for about 11 years. My area of concern is from my hair line to about Mid-scalp which has been stable for a few years.

drcole

Pseudopelade does respond quite well to hair transplant surgery once it has burned out.

Scalp biopsies are in general something that must be done properly to get an accurate diagnosis. Each biopsy must contain some hair in the area of involvement or where the scarring alopecia is taking place. rarely, does scarring alopecia involve the entire scalp. a biopsy in an uninvolved area will be of no value. One must take two biopsies. Both must be 4mm in size. One biopsy is sent for a vertical sectioning, while the second biopsy is sent for a horizontal sectioning. It is also extremely important to have the biopsies read by someone experienced in dermatopathology and in reading hair biopsies. if the pathologist has little experience in this field, the diagnosis will be suspect.

mj2323

Dr Cole,
Following up on our conversation from about 9 months ago......
What would your approach be if you were my surgeon? It appears that the pseudopelade has reached the burned-out stage as there has been no inflammation for at least two years in the areas of concern. I met with another HT surgeon and he suggested that we do a small test session (200 grafts) and see what happens with the regrowth of the transplanted area. Have you ever performed a transplant on someone with pseudopelade? If it appears to be at the burnt-out stage can we be reasonably assured that a larger number of grafts(1800-2000) would take successfully?

Thanks!!