Surgical Management of Scarring Alopecia

*Nuh Evin and Seyda Guray Evin*

### **Abstract**

Cicatricial alopecia presents a heterogeneous group of disorders, which are characterized by the destruction of hair follicles, and resulting in scarring and irreversible hair loss. Cicatricial alopecia is classified into two categories depending on the target pathological process. In primary cicatricial alopecia (PCA), the hair follicle is the sole target of a progressive inflammatory process in various skin or systemic diseases. In secondary cicatricial alopecia (SCA), non-specific and generalized disruption of the skin and skin appendages results in fibrotic scarring of the skin and permanent loss of hair follicles due to underlying disease or an external agent. The aim of the treatment of PCA is to reduce inflammation and prevent progression to irreversible alopecia by using immunosuppressive and antimicrobial agents at the earliest phase of the disease. When permanent hair loss occurs in PCA and SCA, scar tissue should be removed or camouflaged by surgical treatment. However, it is difficult to remove the existing scar and treat alopecia. Follicular unit extraction technique hair transplantation is a minimally invasive and alternative treatment with a high success and satisfaction rate in the treatment of cicatricial alopecia.

**Keywords:** cicatricial alopecia, follicular unit extraction, hair follicle unit, hair transplantation, scarring alopecia

### **1. Introduction**

Head and neck, and body have important hair-bearing aesthetic subunits; scalp, eyebrow, eyelash, mustache, beard, axilla, pubis and other body hairs. They are a fundamental component of facial expression, individual's images, religious beliefs, social and psychological health, personality and sexuality [1–3].

Alopecia is a clinical condition characterized by hair loss of hair-bearing aesthetic subunits and is divided into two main categories; scarring (also described as cicatricial) and non-scarring alopecia (**Table 1**) [3–6]. In non-scarring alopecia, the hair follicles remain intact and their regrowth abilities are preserved [3–6]. However, permanent hair loss may occur in the late stages of non-scarring alopecia, called "biphasic alopecia" [7]. Androgenic alopecia is the most common type of non-scarring hair loss that affects nearly half of men. It is characterized by temporal recession and vertex balding in men, diffuse hair thinning and intact frontal hairline in women [4–6, 8].


*Alopecia Management – An Update*

> **Table 1.** *Theclassification*

 *of alopecia subgroups.* *Surgical Management of Scarring Alopecia DOI: http://dx.doi.org/10.5772/intechopen.107323*

Cicatricial alopecia presents a heterogeneous group of disorders, which are characterized by destruction and fibrous tissue replacing of the hair follicles, resulting in scarring and permanent hair loss. Cicatricial alopecia is classified into two categories depending on the target of the pathological process; primary cicatricial alopecia (PCA) and secondary cicatricial alopecia (SCA) (**Table 1**). In PCA, the hair follicle is the primary and sole target of a progressive inflammatory process in various skin or systemic diseases [4, 6, 7, 9, 10]. In SCA, non-specific and generalized disruption of the skin and skin appendages results in fibrotic scarring of the skin and permanent loss of hair follicles due to underlying disease or an external agent [3, 6, 7, 10, 11]. If scarring alopecia is small, it is not a significant cosmetic problem; however, if it is large, it negatively affects the quality of life, body image, self-image and self-esteem; causes depression, anxiety, psychological burden, social embarrassment, marital and career-related problems [1–3, 7, 11–19].
