Hair Transplant in Patchy Scarring Alopecia of the Fronto-Temporal Area.

Abstract

Introduction: Patchy scarring alopecia in the fronto-temporal areas presents a diagnostic challenge, requiring accurate recognition for proper management. Cicatricial marginal alopecia (CMA) and frontal fibrosing alopecia (FFA) are key differential diagnoses, distinguishable through histopathology. FFA has variable prognosis, depending on typical or atypical patterns. Literature on hair transplantation (HT) in CMA and FFA is limited, with inconsistent outcomes and little data on FFA subtypes. This study aimed to describe HT outcomes in patients with atypical FFA patterns.

Case presentation: Patients were followed at the Municipal Public Servant Hospital of São Paulo, Brazil, from 2016 to 2023. Three postmenopausal women with patchy FFA confirmed by clinical and histological criteria underwent HT using the follicular unit transplantation technique. Over 5 to 6 years of follow-up, two patients had mild graft loss, and one experienced more significant loss. No clinical signs of disease reactivation were observed.

Conclusion: Despite the small sample size and retrospective design, this study offers valuable insight into long-term graft survival in atypical FFA. Mild hair density reduction occurred after more than 5 years, with all patients reporting high satisfaction with aesthetic results. Larger prospective studies are needed to confirm long-term HT efficacy in this population.