Changing trends in hair restoration surgery

Androgenetic alopecia is an important and common cause for baldness. Despite recent advances, the drug therapy of this condition remains unsatisfactory. Surgical hair restoration is the only permanent method of treating this condition. Introduction of recent techniques such as follicular unit transplantation have improved the cosmetic results and patient satisfaction. This article discusses the latest trends in hair restoration surgery.     

Basal cell carcinoma in a hair transplant recipient site.

A basal cell carcinoma developed in the central scalp of a forty-one year old man at the recipient site of a hair transplant plug that was placed five years previously. The patient was never noted to have premalignant or other malignant skin lesions. Although the relationship is probably coincidental, medico-legal factors dictate consideration of a cause and effect relationship.     

Factors influencing postoperative hyperesthesia in hair restoration surgery

Background While esthetic outcomes in hair restoration surgery (HRS) have improved markedly since the advent of follicular unit transplantation (FUT), various undesirable sequelae persist. We investigated the technical and demographic variables that may contribute to the frequency of postoperative hyperesthesia. Methods A multicenter retrospective chart review involving 552 patients undergoing HRS from 1999 to 2009. Results A total of 19 patients (3.4%) reported postoperative hyperesthesia in either the donor or recipient area of their scalp. Although many trends emerged, one variable significantly influenced the rate of this neurosensory symptom. While no patient who had all previous and current HRS sessions performed entirely within the same investigated surgical practice (n = 42) experienced postoperative hyperesthesia, 14% of our patients who underwent prior HRS by a physician outside of the investigated surgical group (n = 35) developed this complication (P = 0.0404). The amount of intraoperative electrocautery to maintain hemostasis (P = 0.0897), degree of tension upon donor wound closure (P = 0.3044), and extent of donor wound edge undermining (P = 0.4420) influenced the frequency of this sequela to a lesser degree. Conclusion These results suggest that physicians planning repair sessions on patients who have undergone prior HRS by a physician at a different surgical center should include the specific caveat of increased incidences of postoperative hyperesthesia in their preoperative consultation.     

Receptor site dominance after hair transplantation in alopecia areata

A 32-year-old woman presented with a patchy and ophiasis type of alopecia areata. She reported that at the age of 25 she had undergone plastic surgery for the same hair problem. In the occipital region, partial excision of bald areas and transplantation of punched grafts from unaffected areas of her scalp had been performed, but these grafts completely lost their hair shortly after transplantation. At the age of 30 she had developed, in addition, patchy alopecia areata in other areas of the scalp. The present observation of receptor site dominance of the area affected by alopecia areata suggests that the primary abnormality is situated in the affected tissue, and that the disease is caused by local spreading of a hitherto unknown factor.     

Roxithromycin antagonizes catagen induction in murine and human hair follicles: implication of topical roxithromycin as hair restoration reagent

Roxithromycin (RXM) is a 14-member macrolide antibiotics, with a variety of bioregulatory functions including anti-apoptotic activity to keratinocytes. Therefore, RXM has been used for many kinds of skin diseases. In this study, human and murine hair follicles were treated with RXM in order to find the possibility to cure hair loss disease such as androgenetic alopecia (AGA). In AGA, dihydrotestosterone signals apoptosis in dermal papilla cells in susceptible individuals, resting in premature termination of anagen and early entry into catagen. Therefore, anti-apoptotitic drug has a possibility of new candidate for AGA. This study revealed RXM antagonized the in vitro inhibitory effect of IFN-γ on proliferation of keratinocytes and induction of apoptosis in murine and human hair bulb. RXM increases hair elongation and inhibits catagen-like changes induced in vitro with IFN-γ in murine and human hair follicles. Furthermore, topical 5% RXM solution effectively restores hair growth in about half of individuals with AGA without any local and systemic adverse effects. Therefore, RXM is new candidate as a hair restoration drug for AGA.     

Suction blister grafting for stable vitiligo using pulsed erbium:YAG laser ablation for recipient site

BACKGROUND: Suction blister grafting was performed via a modified simple technique using a 20-mL syringe to create the donor graft and pulsed erbium:YAG laser ablation of the recipient site. METHODS: Two patients with stable vitiligo and one with postinflammatory depigmentation were studied. RESULTS: The grafts took well in all three patients and pigmentation was retained at 20 weeks. No complications occurred. CONCLUSIONS: The erbium:YAG laser is an ideal tool for creating graft recipient sites, given its precision in terms of width and depth of ablation. A 20-mL syringe can be used to create a blister of adequate size.     

Risk factors for surgical site infection after dermatological surgery

Objectives Surgical site infection (SSI) following minor surgery contributes to patient morbidity and compromises cosmetic outcomes. The purpose of this study was to determine the incidence of and risk factors for SSI after dermatological surgery in general practice. Methods A prospective, observational study which assessed infection among 972 patients was conducted in regional north Queensland, Australia. Consecutive patients presenting for minor skin excisions were invited to participate. Wounds were assessed for SSI at the time of removal of sutures. Results Infection occurred in 85 of the 972 excisions; thus, the overall incidence of infection was 8.7% (95% confidence interval 6.5–11.0). Excisions in the upper (P < 0.001) or lower (P < 0.001) extremities, excisions of basal cell carcinoma (BCC) (P = 0.001) or squamous cell carcinoma (SCC) (P = 0.001), and re‐excision of skin cancer were found to be independent risk factors for wound infection. The length of the excision (P < 0.001) and the patient’s status as an ex‐smoker (P = 0.019) were additional independent risk factors for infection. Diabetes was not found to be an independent risk factor for infection (P = 0.891). Conclusions Prophylactic antibiotics are probably prescribed excessively or inappropriately for dermatological surgery, and overall we wish to discourage their use. The results of this study may encourage the more judicial use of prophylactic antibiotics by defining high‐risk procedures, such as excisions from the extremities, excision of BCC or SCC, and larger excisions, and patients who are at high risk for infection, such as ex‐smokers.