Postoperative permanent pressure alopecia

Abstract

A 49-year-old Chinese female underwent elective laparoscopic assisted Whipple's surgery lasting 12 h. This was complicated by postoperative pressure alopecia at the occipital area of the scalp. Pressure-induced hair loss after general anaesthesia is uncommon and typically temporary, but may be disconcerting to the patient. We report this case of postoperative permanent pressure alopecia due to its rarity in the anaesthesia/local literature, and review the risk factors for its development.

Headgear-induced temporary pressure alopecia

“…The majority of case reports of pressure alopecia have been observed following extended surgical procedures, giving rise to the alternative name of postoperative alopecia (Abel and Lewis, 1960; Bagaria and Luck, 2015; Chang et al, 2016; Domínguez-Auñón et al, 2004; Huang et al, 2018; Iwai et al, 2009; Lawson et al, 1976; Matsushita et al, 2011; Wiles and Hansen, 1985). Other causes of pressure alopecia reported in the literature include electroencephalogram electrodes (Kunapareddy et al, 2018; Morris et al, 1992), headbands (Sano et al, 2018), fixed head positioning while watching television (Thiem et al, 2016) and breakdancing (Bonifazi, 2006).…”

“…It presents as one or more rounded patches and exhibits clinical phases of activity, inactivity and regrowth (Eudy and Solomon, 2006). Unlike pressure alopecia, alopecia areata has no prodromata; pressure alopecia, however, follows prolonged pressure to an area of the scalp and may be preceded by erythema, swelling, exudate, crusting and tenderness (Abel and Lewis, 1960; Bagaria and Luck, 2015; Chang et al, 2016; Wiles and Hansen, 1985). Abel and Lewis (1960) also reported faster and prompter hair regrowth in areas of pressure alopecia compared to alopecia areata.…”

“…Wiles and Hansen, 1985;Chang et al, 2016; Bagaria and Luck, 2015).Abel and Lewis (1960) also reported faster and prompter hair regrowth in areas of pressure alopecia compared to alopecia areata.…”

Alopecia

“…Pressure alopecia is a patchy, non-cicatricial or cicatricial alopecia occurring on the scalp areas submitted to a prolonged pressure (tight headband), usually during surgeries (postsurgical alopecia), and immobilization by coma of various causes including diabetic ketoacidosis [45,46]. Pressure alopecia results from prolonged pressure that causes ischemia of the skin, cutaneous appendages, and subcutaneous fat.…”

“…The length of surgery has been postulated to influence to the development of permanent hair loss [48]. Psychological states such as anxiety and mood disorder and obesity might predispose individuals to postoperative hair loss [45]. Necrosis, ulcer, and cicatricial alopecia can result.…”