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20-10-2011 | Surgery | Article

Face and scalp cosmetic surgery may increase lichen planopilaris risk


Free abstract

MedWire News: Evidence suggests that cosmetic procedures such as facelifts and hair transplants can increase the risk for lichen planopilaris (LPP), an inflammatory skin disorder that results in permanent alopecia and fibrous scarring over the hair follicles, or frontal fibrosing alopecia (FFA), say researchers.

Matthew Harries (University of Manchester, UK) and colleagues explain that although there is a lack of published evidence linking hair transplantation and facelift surgery to LPP and FFA, they have observed a number of such cases suggesting that there may be a link.

Writing in the Journal of the American Academy of Dermatology, the researchers describe 10 patients who developed LPP or FFA following cosmetic surgery; seven who developed LPP following hair transplantation, and three who developed FFA after cosmetic facelift surgery.

Four of the patients who developed LLP were men, and all the patients who developed FFA were women. The patients were aged from 34 to 63 years (mean age 52.4 years). None of the patients had a prior history of LPP or FFA.

The symptoms of LPP/FFA seen in these patients did not differ from the normal symptoms seen in people with these conditions and included peri-follicular erythema, follicular hyperkeratosis, and loss of visible follicular ostia in the areas of affected scalp.

The team notes that these 10 patients represented 5.9% of the total LPP/FFA cases seen in their centers over a 2-year period (111 LPP and 58 FFA cases in total).

Harries and team explain that a possible explanation for the association could be the Koebner phenomenon, where "the development of lesions characteristic of a particular disease occurs at the site of physical trauma or some other noxious stimulus (isomorphic reaction)."

This phenomenon has previously been reported for other skin diseases including psoriasis, lichen planus, and vitiligo.

In addition, "growing evidence supports the hypothesis that localized immunosuppressive mechanisms present in the proximal follicle and bulge region of normal anagen hair follicles (termed "immune privilege"), may be defective in LPP," write the authors.

Therefore, another possible explanation for the link between cosmetic surgery and LPP/FFA could be that "a post-surgery pro-inflammatory milieu inducing hair follicle immune privilege collapse and follicular damage," occurs in susceptible people.

Harries et al say that "LPP post-hair transplant may be misdiagnosed as transplant rejection by those who are not experienced in hair disorders."

They conclude: "Dermatologists, hair transplant and cosmetic surgeons should maintain a high index of clinical suspicion of this condition, and ensure that all patients with alopecia are routinely and systematically examined by scalp dermoscopy to screen for signs of scarring alopecia."

By Helen Albert

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