Hair Transplantation in Primary Cicatricial Alopecias: A Review and Update
Abstract
1. Introduction
2. Material & Methods
2.1. Search Strategy
2.2. Inclusion/Exclusion Criteria
3. Results
3.1. Study Selection
3.2. Characteristics of Included Patients
3.3. Outcomes by Subtype
3.4. Surgical Techniques Used
4. Discussion
4.1. Pathophysiology
4.2. General Considerations
4.2.1. Patient Evaluation
4.2.2. Timing
4.2.3. Test Transplant
4.2.4. Factors Affecting Graft Survival
4.2.5. Techniques to Improve Graft Survival
4.2.6. Adjunctive Treatment
4.3. Subtype-Specific Considerations
4.3.1. Lichen Planopilaris (LPP)
4.3.2. Frontal Fibrosing Alopecia (FFA)
4.3.3. Central Centrifugal Cicatricial Alopecia (CCCA)
4.3.4. Discoid Lupus Erythematosus (DLE)
4.3.5. Folliculitis Decalvans
4.3.6. Morphea en Coup de Sabre
4.3.7. Pseudopelade of Brocq
4.3.8. Fibrosing Alopecia in a Pattern Distribution (FAPD)
4.3.9. PCA Post-Transplant
4.3.10. Other Subtypes
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Data Availability Statement
Conflicts of Interest
References
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Subtype | N | Remission Period | Methods | Outcomes |
---|---|---|---|---|
LPP | 39 | 0.5–3.6 yr | FUE, punch | Mostly positive; 70–90% survival * |
FFA | 58 | 0–5 yr | FUT, FUE | Mixed; early growth, frequent loss by 4–5 yr |
Eyebrow FFA | 12 | Not specified | FUT, FUE | Short-term positive; majority lost by 3–4 yr |
DLE | 9 | 0–2 yr | Punch, FUT | Positive |
CCCA | 3 | <1–>2 yr | Punch, FUE | Positive; modest survival (~60%) |
Folliculitis decalvans | 12 | >0.5 yr | FUE | Positive in 9; 3 failures with reactivation |
Morphea (ECDS) | 2 | 1 yr | FUE | Positive |
Pseudopelade | 7 | 0–3.6 yr | FUE, punch | Positive; generally favorable in end-stage disease |
PCA Subtype Post-HT | N | Methods Used | Interval Post-HT | Outcome Summary |
---|---|---|---|---|
LPP | 41 | FUE, FUT, punch | 3 mo–9 yr | Variable: <5% to 80% survival, some stabilization, frequent graft loss |
FFA | 1 | Punch/minigraft | >5 yr | Loss of follicles |
Folliculitis decalvans | 1 | Punch grafts | 20 yr | Loss of follicles |
EPD | 2 | FUE or FUT | ~12 mo | <50% graft survival, repeat HT successful |
Dissecting cellulitis | 1 | FUE | 4 mo | Regrowth with medical therapy |
Characteristic | Non-Scarring Alopecia | Scarring Alopecia |
---|---|---|
Definition | Hair loss without permanent follicular destruction; follicles remain intact | Hair loss due to permanent follicular destruction and fibrosis |
Etiology | Commonly androgenetic alopecia, telogen effluvium, alopecia areata | Autoimmune, inflammatory, or infectious conditions (e.g., lichen planopilaris, frontal fibrosing alopecia, discoid lupus erythematosus, central centrifugal cicatricial alopecia, folliculitis decalvans) |
Follicular unit survival | High; follicles viable | Lower; destruction and fibrosis |
Scalp vascularity | Preserved | Compromised |
Inflammation | Minimal to none | Active or subclinical |
Risk of progression post-HT | Low | Moderate to high; risk of reactivation |
Candidate selection | Most AGA patients are candidates; outcomes usually satisfactory | Very selective; depends on disease stability and donor availability |
Recommended stability period | Not required | 12–24 months (some success with <6 months) |
Test area | Not required | Always recommended |
Donor harvesting | FUT or FUE both options | FUT or FUE both options; FUE often preferred |
Recipient site optimal density | Density 20–35 grafts/cm2 | Lower density (20–25 grafts/cm2); angle adjustments often needed |
Number of procedures | Usually 1 (sometimes 2–3) | Often multiple staged sessions |
Transplant success rate | >90% graft survival | 50–80% graft survival (subtype-dependent) |
Patient satisfaction | Very high | Very high (with appropriate counseling) |
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Queen, D.; Avram, M.R. Hair Transplantation in Primary Cicatricial Alopecias: A Review and Update. Surgeries 2025, 6, 80. https://doi.org/10.3390/surgeries6040080
Queen D, Avram MR. Hair Transplantation in Primary Cicatricial Alopecias: A Review and Update. Surgeries. 2025; 6(4):80. https://doi.org/10.3390/surgeries6040080
Chicago/Turabian StyleQueen, Dawn, and Marc R. Avram. 2025. "Hair Transplantation in Primary Cicatricial Alopecias: A Review and Update" Surgeries 6, no. 4: 80. https://doi.org/10.3390/surgeries6040080
APA StyleQueen, D., & Avram, M. R. (2025). Hair Transplantation in Primary Cicatricial Alopecias: A Review and Update. Surgeries, 6(4), 80. https://doi.org/10.3390/surgeries6040080