When is the Appropriate Time to do Hair Transplantation in Recalcitrant Alopecia Areata, or Never?

Abstract

Alopecia areata (AA) is a common and distressing condition in populations worldwide. The course of this condition is unpredictable and remains elusive. Patients with AA have a negative appraisal of their self-image, resulting in a demand for any effective treatment options. Hair transplantation might be considered for those patients who have exhausted standard clinical therapies for a period of time. However, the appropriate time to do hair transplantation in recalcitrant alopecia areata is still in question, or may be never. Keywords: Alopecia areata; Hair transplantation Case ReportA 31-year old Asian male presented with a 6-year history of patchy hair loss on his scalp and right eyebrow. He was initially seen by dermatologists and had been treated with topical corticosteroids, intra lesional corticosteroid and 5% minoxidil lotion for the past 5-6 years without improvement. There was no history of autoimmune diseases, thyroid diseases or atopy as well as, no family history of alopecia areata. Examination of the scalp showed a non-scarring alopecic patch sized 3.5×6.5 cm on the right frontal area and another non-scarring alopecic patch sized 1×1 cm on the right eyebrow (Figures 1a and 2a). Pull test was negative on both sites. Pitting nails were not observed.Scalp and eyebrow were biopsied with standard 4 mm punches. The histopathology of the biopsy from the scalp showed decreased hair follicles in anagen phase and lymphocytic infiltration around the hair bulbs and fibrous tissue. The biopsy from the eyebrow revealed only decreased number of the hair follicles. The histopathology results were consistent with alopecia areata.