A Systematic Review of the Outcome of Hair Transplantation in Primary Scarring Alopecia

ImportanceHair loss, or alopecia, is one of the most commonly presented problems in dermatology. Scarring alopecias are considered particularly damaging due to limited success in slowing permanent disease progression, and current treatment methods, such as intralesional and topical steroids and topical minoxidil, are largely ineffective.ObjectiveHair transplantation is a debated treatment option for advanced cases of primary scarring alopecia. This study reviews the efficacy of hair transplantation as a treatment option for primary scarring alopecia.Evidence reviewA primary literature search was conducted using PubMed to identify articles in scarring alopecia and hair transplants published from 1960 to the present time.FindingsFifteen reports with 34 patients were included in this review. Twenty six patients experienced moderate to positive results, while 8 patients experienced negative results or recurrence of disease. Positive hair transplantation results have been reported in patients with central centrifugal cicatricial alopecia, en coup de sabre, discoid lupus erythematous, pseudopelade de brocq, and folliculitis decalvans. Positive and -negative results were observed in patients with lichen planopilaris and frontal fibrosing alopecia.Conclusion and relevanceFindings show that hair transplant surgery can be considered as a treatment option for certain primary scarring alopecias. However, data must be interpreted with caution due to concern for positive-result publication bias