Evaluation of perifollicular inflammation of donor area during hair transplantation in androgenetic alopecia and its comparison with controls

Abstract

Background:Mild perifollicular inflammation is seen in both androgenetic alopecia (AGA) cases and normal controls, whereas moderate or dense inflammation with concentric layers of collagen, is seen in AGA cases but only in very few normal controls, and may lessen the response to topical minoxidil. Moderate or dense lymphocytic inflammation and perifollicular fibrosis have poor hair growth following transplantation.Aim:The purpose of the study is to evaluate the perifollicular lymphocytic inflammation and fibrosis in AGA patients during follicular unit hair transplantation (FUT) and its comparison in normal controls.Materials and Methods:A total of 21 male patients with AGA and 7 matched controls participated in the study. Histopathological analysis of biopsy specimens from donor strip of patients during the hair transplantation and two 4 mm punch biopsies on controls were performed. Morphometric analysis was performed and perifollicular fibrosis was scored based on the width of the condensed collagen at the lower infundibulum and isthmus from 0 to 3. Perifollicular infiltrate was also scored 0-3 and a total score of 3 or more out of 6 was considered significant.Results:Nearly 76% of AGA patients had perifollicular fibrosis more than 50 μm at ×200 magnification. Almost 33.33% patients had moderate/dense perifollicular lymphocytic infiltrate whereas none of the controls had it. Total score in AGA cases was significantly higher than controls (P = 0.012) using Chi-square test. Out of 21 patients, 13 had a score of 3 or more and were followed-up with monthly treatment with intralesional steroids using a dermaroller.Conclusion:Histopathological evaluation of the donor area is a must during hair transplantation to evaluate the extent of perifollicular inflammation and achieve better results by following it up with treatment directed to decrease the inflammation.

Unveiling a Shared Precursor Condition for Acne Keloidalis Nuchae and Primary Cicatricial Alopecias

“…It was also performed in an AKN specialty clinic, which may skew the study population towards more advanced and treatment-resistant diseases. Since previous trichoscopy and histologic NAS studies of non-balding healthy patients showed no significant evidence of PIILIF, 25 , 63 , 64 , we did not believe a prospective control cohort was necessary to validate our findings.…”

Autologous hair transplantation in frontal fibrosing alopecia

“…In any case, care should be given that the donor area for transplantation is checked for evidence of follicular inflammation,[ 28 ] follicular unit test grafting should precede the procedure,[ 29 30 ] and the patient should be carefully followed up posttransplantation, while at the same time active disease in the proximity of the transplants is actively treated, preferably with a topical calcineurin inhibitor[ 31 ] that does not impair wound healing.…”

Physiopathology and current treatments of androgenetic alopecia: Going beyond androgens and anti‐androgens

“…While mild perifollicular inflammatory signs can be seen in 76% of patients with AGA and also in 30% of normal controls, more advanced levels of inflammation with deposition of concentric layers of fibrotic collagen (perifollicular fibrosis) is seen in AGA patients but not in normal controls (Nirmal, Somiah, Sarvajnamurthy, Biligi, & Palo, ). This inflammatory scenario can be caused by the microbial flora, oxidative stress, aging, smoking, UV radiation, and pollutants (Rossi et al, ) and can induce, as a final consequence, the follicular atrophy with no possibility of regeneration of hair follicles (Trüeb, ).…”