A new approach to treating scarring alopecia by hair transplantation and topical minoxidil.

Sir, The term “scarring alopecia” implies the potential of permanent destruction of hair follicle. Scarring alopecia occurs in otherwise healthy men and women of all ages and is seen worldwide.[1,2] Most likely it is caused as a result of irreversible damage to the epithelial hair follicle stem cells in the region of bulge. [3,4] It consists of diverse group of rare disorders that destroy the hair follicle, replace it with scar tissue, and cause permanent hair loss. In some cases, the hair loss is gradual, without symptoms, and is unnoticed for long periods. In other cases, the hair loss is associated with severe itching, burning and pain and is rapidly progressive. The inflammation that destroys the follicle is below the skin surface and there is usually no “scar” seen on the scalp. Affected areas of the scalp may show a few signs of inflammation, or have redness, scaling, increased or decreased pigmentation, pustules, or draining sinuses. Treatment of the lymphocytic group of scarring alopecia’s involves the use of anti-inflammatory medications such as steroids, cyclosporine, and hydroxychloroquine. When hair follicles get destroyed, hair will not grow back. However, in some cases, using minoxidil solution can help to stimulate the growth of some of the remaining hair. Hair transplant could only be used in patients who have normal healthy hair in donor area.[5] Scar revisions with/without a tissue expander and flaps are the major surgical procedures for scarring alopecia, and there have been few reports on hair transplantation into scar tissue. There is an apprehension of a lower survival rate of donor hair for scarring alopecia due to a poorer blood supply. However, hair transplantation can also show good results by using appropriate techniques and guidelines.[6]