Hair Transplantation in Frontal Fibrosing Alopecia and Lichen Planopilaris: A Systematic Review

Abstract

Objective: Evolving hair transplantation (HT) techniques have offered new possibilities for hair restoration. However, the role of HT in patients with frontal fibrosing alopecia (FFA) and lichen planopilaris (LPP) remains unclear. This study aims to evaluate the outcomes and temporal relationship of HT in this population. Methods: A literature search of three databases was conducted. We reviewed 1) literature reporting outcomes of patients with LPP or FFA who received HT, and 2) studies reporting the development of LPP or FFA resulting from HT. Results: Thirteen articles included 42 patients that provided data for evaluation. Fifteen patients had previously been diagnosed with FFA or LPP, and the remaining 27 patients developed disease after undergoing HT. Seven patients with FFA and eight patients with LPP received HT, with a mean sustained disease remission of 2.69 years prior to HT. In total, two of seven (29%) patients with FFA and five of eight (75%) patients with LPP experienced positive HT results over a follow‐up period of 8–72 months. Interestingly, 27 patients without evidence of previous disease developed FFA or LPP following HT after a median duration of 16 months. Conclusions: HT for LPP and FFA is feasible but results may be less favorable compared to HT for other causes. Outcomes may be more favorable for LPP than FFA but this was not statistically significant and evidence is very limited. FFA and LPP can also develop following HT in patients without previous evidence of disease. Level of Evidence: NA Laryngoscope, 131:59–66, 2021

Frontiers in Lichen Planopilaris and Frontal Fibrosing Alopecia Research: Pathobiology Progress and Translational Horizons

“…On the basis of recent studies and as depicted in Figure 3 a , intracutaneous pathobiology elements and locally active environmental factors seem to be the key factors in the development of both LPP and FFA ( Chiang et al., 2015 , 2012 ; Harries et al., 2020 , 2018 ). Such environmental factors may include skin trauma due to hair transplantation (triggering LPP development) and/or face lift surgery (inducing FFA) ( Chiang et al., 2012 ; Lee et al., 2021 ; Vañó-Galván et al., 2019b ), psychoemotional stress and stress mediators (e.g., substance P [SP] induces neurogenic inflammation and immune privilege [IP] collapse of human scalp HFs [ Peters et al., 2007 ], whereas noradrenaline can induce the proliferation and thus exhaustion of HF melanocytes stem cells (SCs) in mice [ Zhang et al., 2020 ]; indeed, LPP and FFA HFs show loss of melanocytes [ Lin et al., 2017 ; Salas-Callo et al., 2021 ]), and certain leave-on cosmetics whose relevance in FFA is currently intensely being debated ( Aldoori et al., 2016 ; Debroy Kidambi et al., 2017 ; Strazzulla et al., 2017 ). All these may trigger the recruitment of a pathogenic immune cell infiltrate to the HF, possibly along with dysbiosis of the HF microbiome ( Constantinou et al., 2021b ; Lousada et al., 2021 ), thus further perpetuating the perifollicular inflammation.…”

Lichen planus – a clinical guide

“…Hair transplantation in LPP should be planned at the earliest one year after disease control [123]. In particular, the results of hair transplantation in FFA are inferior to those in LPP [124]. Since there are reports of LPP as a result of hair transplantation [125] such a procedure should be discussed in great detail with the patient and potential risks should be pointed out [126].…”

Frontal Fibrosing Alopecia – a review and a practical guide for clinicians

“…A more severe course of FFA seems to be related with the higher age of the patient, higher age at onset of the disease, longer duration of the disease, low academic level and higher body mass index [17]. Interestingly, many patients without evidence of previous disease developed FFA after surgery (hair transplantation or facial lifting), which could be explained by a Koebner response or a collapse of hair follicle immune privilege [18,19,20]. While the cause of FFA remains unknown, there are several factors that are considered to play a role in the pathogenesis of the disease: Autoimmunization is due to the histopathological image of a dense lymphocytic infiltrate and fibrosis seen around the infundibulum and isthmus of the hair follicle [6].…”