Dense-packing hair grafting technique for restoration of cicatricial alopecia

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Zhonghua Zheng Xing Wai Ke Za Zhi 2002 Jul;18(4):219-20

Dense-packing hair grafting technique for restoration of cicatricial alopecia

OBJECTIVE: To investigate the possibility of using dense-packing hair grafting technique for restoration of cicatricial alopecia. METHODS: Under local anesthesia, a scalp strip was harvested from the back of the head. A series of micro-grafts with 1-3 hairs and mini-grafts with 4-6 hairs were created from this strip. In the scarring recipient area, micro-slots were made with a 18 G needle for the micro-grafts and mini-slits were made with a No. 64 mini-blade for the mini-grafts. The grafts were then implanted into these holes. RESULTS: Ninety-six patients with 128 bald scarring areas, resulted from burn, trauma or infection, were treated with the above-mentioned technique from April. 1998 to February. 2000. All of the patients were satisfied with the appearance. In the micro-graft area, the graft density reached 10-15 mini-grafts/cm2 per session. In the micro-graft area, the graft density reached 16-19 micro-grafts/cm2 per session. Postoperative following-up for more than 1 year showed that the grafted hairs were growing well with 90%-95% survival of the hair. One third of the patients obtained satisfactory results with only one session. Two thirds of the patients needed the second session to improve the appearance. CONCLUSIONS: The dense-packing hair grafting technique is a simple, safe and effective method for hair restoration surgery. It is not only used for male pattern baldness, but could also be applied for restoration of cicatricial alopecia.

Arch Dermatol 2002 Jul;138(7):916-22

Mediation of alopecia areata by cooperation between CD4+ and CD8+ T lymphocytes: transfer to human scalp explants on Prkdc(scid) mice.

OBJECTIVE: To determine the role of CD4+ and CD8+ T lymphocytes in the pathogenesis of alopecia areata. DESIGN: Relapse of alopecia areata was induced in autologous human scalp grafts on Prkdc(scid) mice by injection of activated T lymphocytes derived from lesional skin. CD4+ and CD8+ T cells were separated by magnetic beads before injection. SETTING: University-based dermatology practice. PARTICIPANTS: Eleven patients with either alopecia totalis or severe alopecia areata. MAIN OUTCOME MEASURES: Hair regrowth, hair loss, and immunohistochemical findings of scalp explants. INTERVENTION: Transfer of scalp T cells to autologous lesional scalp explants on Prkdc(scid) mice. RESULTS: Injection of unseparated T cells and mixed CD4+ plus CD8+ T cells resulted in significant hair loss (P<.01) in 5 of 5 experiments. However, injection of purified CD4+ or CD8+ T cells alone did not result in reproducible hair loss. CD4+ and CD8+ T cells induced follicular expression of intercellular adhesion molecule 1 (CD54), HLA-DR, and HLA-A, HLA-B, and HLA-C after injection into scalp grafts. CONCLUSIONS: CD4+ and CD8+ T cells have a role in the pathogenesis of alopecia areata. It is hypothesized that CD8+ T cells act as the effector cells, with CD4+ T cell help. It is now necessary to look for HLA-A, HLA-B, and HLA-C associations with alopecia areata. Therapeutic manipulations that interfere with CD8+ activity should be examined.

J Eur Acad Dermatol Venereol 2000 Mar;15(2):137-9

The effect of hair loss on quality of life.

BACKGROUND: The aim of this study was to quantify the effect of hair loss on quality of life. Patients were recruited from an alopecia support group, and were assessed using the Dermatology Life Quality Index (DLQI) and an adapted version of the DLQI. Financial utility questions, an abbreviated version of the Center for Epidemiologic Studies Depression Scale and open-ended questions were also used. OBSERVATIONS: Seventy (90% response rate) questionnaires were returned. DLQI scores in responders with hair loss (mean score = 8.3, SD = 5.6, range 0-23, n = 70) were similar to those recorded in severe psoriasis. The hair loss continued to have a significant impact on life quality well after the initial event (median duration of hair loss = 138 months +/- 114; range 7-588, n = 70). Forty per cent of patients also felt dissatisfied with the way in which their doctor dealt with them. CONCLUSIONS: This study specifically identifies the feelings of loss of self-confidence, low self-esteem and heightened self-consciousness in people affected by hair loss.

Pediatrics. 2003 Mar;111(3):685-7.

Toe tourniquet syndrome in association with maternal hair loss.

Increased hair loss a few months after delivering an infant is a common postpartum condition known as telogen effluvium. A much less common condition involving young infants is the hair-thread tourniquet syndrome, or toe tourniquet syndrome, which involves hair or thread becoming so tightly wrapped around an appendage that pain, injury, and sometimes loss of the appendage result. This case report is the first known description of the hair-thread tourniquet syndrome in association with maternal telogen effluvium. A literature review shows that accidental cases involving human hair almost always involve the toes, and usually occur at the age when mothers are experiencing excessive hair loss. This association is significant in that anticipatory guidance of new parents experiencing rapid hair loss may prevent cases of the toe tourniquet syndrome and its associated morbidity.

Being such a complex biological process, hair growth biology is still a work in progress. Noetheless, several therapeutic methods, including drugs, surgery, and suppelements have been in use to help those who attempt to restore their hair. None of these approaches are perfect due to the diversity in the causes underlying hair loss. Also, most of chemical drugs and hair transplantation surgeries are accompanied by undesirable side effects.

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