Alopecia areata is a common autoimmune skin disorder with an unpredictable clinical course. When the face is affected it makes the appearance of the patient unpleasant. The treatment of alopeaisa areate is challenging for both the patient and thephysician. One of the treatment modality for the hair loss of eyebrow is hair transplantation (1-3). In this case report we present the long term result of the hair transplantation in a patient whom had a therapy-resistant alopecia areata affecting both eyebrows.
Methods/Technique:
Case Report: A 24-year-old male patient was treated with hair transplantation for therapy-resistant alopecia areata affecting both eyebrows in 2007. At the time of hair transplantation he gave a history of quick loss of all body hair and treatment with psoralen and ultraviolet A (PUVA) therapy for alopecia universalis 4 years previously. He reported that all body hair re-grew except his eyebrows within the two years period. Although the patient had various medical therapeutic agents there was no eyebrow re-growth.This led to a major psychological impact on the life of the patient. Prior to hair transplantation, alopecia areata of the eyebrows was stable for 18 months following the last medical treatment. Since than the patient had hair transplantation with using the follicular unit extraction (FUE) technique. 350 single -hair and 75 two-hair containing grafts, harvested from occipital area, were used to reconstruct both eyebrow alopesia. The hair re-growth rate was 80% without any topical or systemic therapies for alopecia areata at the end of the 24th postoperative month. This result was accepted for publication in 2009 (1). However, the patient applied with the complaint of double eyebrow appearance due to re-grew of original eyebrows without use of any local or systemic therapy for alopecia areata at the end of 3rd postoperative year (Figure-1). This un expected complication make the appearance of the patient very unpleasent. We have decided to wait for at least one year to conclude that clinical course of the disease is stable and following that period we are planning to remove the transplanted hairs via laser epilation.
Results/Complications:
3 years following the hair transplantation with using FUE technique, the patient displayed spontaneous eyebrow re-growth with a distracting appearance of double eyebrow. At the present time, the transplanted hairs cause embarrassment for the patient and there is a potential therapeutic problem.
Conclusion:
This case clearly shows that waiting for about two years is not enough to decide on any form of surgical intervention for the treatment of therapy resistant alopecia areata. The effect of transplanted hair graft on the alopecia is not known, but the knowledge obtained from limited published papers and this case report show that it may induce the re-growt of original eyebrow or transplanted hair may be lost due to recurrence of the disease (1,2). If hair transplantation is performed the shape and size of the eyebrow to be reconstructed should be the original size and shape to prevent double eyebrow appearance in case of spontaneous re-growth of eyebbrow. It appears that the hair transplantation is not the right choice for the treatment of therapy resistant alopecia areata.
Figure-1
EFERENCES
- Civas E, Aksoy B, Aksoy HM, Eski M, Yucel K. Hair transplantation for therapy-resistant alopecia areata of the eyebrows: is it the right choice? J Dermatol 37(9):823–826, 2010
- Barankin B, Taher M, Wasel N. Successful hair transplant of eyebrow alopesia areata.J Cutan Med Surg. 9:162-164,2005
- Wang J, Fan J. Cicatricial eyebrow reconstruction with a dense-packing one-two- hair grafting .Plast reconstr surg. 114:1420, 2000