Lichen Planopilaris After Hair Transplantation

Hair transplantation (HT) is highly effective in secondary cicatricial alopecias such as after thermal burns, trauma, or radiotherapy-induced alopecia. In contrast, hair transplantation in lichen planopilaris (LPP) can be risky because it can reactivate the disease. For this reason, most hair transplant surgeons consider that LPP can be transplanted if confirmed quiescence has been demonstrated for at least 1 year. What Donovan 2 describes in his paper is the opposite, namely that HT can cause de novo appearance of LPP or reactivation of a subclinical LPP months to years after hair transplantation for androgenetic alopecia. The 17 cases that Donovan reported plus another 10 previously reported 3 suggest that this association is probably real and not a mere coincidence. Surgical trauma as a hypothesis is an intuitive explanation, given that never before have hair transplant surgeons accomplished such megasessions in which thousands of slits are made in the recipient area, although we should not overlook the possibility that a microorganism, which can easily be introduced in the skin through the multiple superficial wounds, could act as an inciting agent of the inflammatory process.