Search Results (2)

Background: Primary cicatricial alopecias (PCA) are inflammatory disorders that cause permanent hair loss through follicular destruction and fibrosis. Hair transplantation (HT) may restore coverage in stable or end-stage PCA cases. This review assesses the efficacy of HT in PCA including optimal timing, graft survival rates, and the risk of disease reactivation. Material & Methods: A PubMed literature search identified 33 studies of HT in lichen planopilaris (LPP), frontal fibrosing alopecia (FFA), discoid lupus erythematosus, central centrifugal cicatricial alopecia, pseudopelade of Brocq, morphea en coup de sabre, and folliculitis decalvans from the 1960s to present. Reviews were excluded. Results: Among 147 PCA patients, 87.8% had positive HT outcomes. LPP showed high graft survival (70–90%). In contrast, eyebrow FFA (75%), folliculitis decalvans (25%), and scalp FFA (8.6%) had the highest failure rates. Follicular unit extraction was used slightly more than follicular unit transplantation. Notably, 46 patients developed PCA post-HT for presumed androgenetic alopecia. Discussion: HT in PCA can succeed with careful patient selection and stable disease (ideally ≥12–24 months). Graft survival varies by subtype. LPP has consistently reported successful outcomes post-transplantation, whereas folliculitis decalvans and FFA had the poorest outcomes. Adjuncts like immunosuppressants, PRP, and minoxidil may enhance results. Conclusions: Hair transplantation is viable in quiescent PCA, but outcomes are subtype-dependent. Many surgeons already perform these surgeries, but the published literature is lacking, and more research is needed to establish standardized timing, improve long-term graft survival, and clarify the risk of post-HT PCA onset. Full article

Primary cicatricial alopecias (PCA) represent a challenging group of disorders that result in irreversible hair loss from the destruction and fibrosis of hair follicles. Scalp skin biopsies are considered essential in investigating these conditions. Unfortunately, the recognised complexity of histopathologic interpretation is compounded by inadequate sampling and inappropriate laboratory processing. By sharing our successes in developing the communication pathway between the clinician, laboratory and histopathologist, we hope to mitigate some of the difficulties that can arise in managing these conditions. We provide insight from clinical and pathology practice into how diagnoses are derived and the key histological features observed across the most common PCAs seen in practice. Additionally, we highlight the opportunities that have emerged with advances in digital pathology and how these technologies may be used to develop clinicopathological relationships, improve working practices, enhance remote learning, reduce inefficiencies, optimise diagnostic yield, and harness the potential of artificial intelligence (AI). Full article