Surgical Management of Scarring Alopecia

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.