Background:
Primary cicatricial alopecias (PCAs) are a clinically diverse group of permanent hair loss disorders characterised by the irreversible destruction and scarring of hair follicles. Follicular unit transplantation (FUT) and follicular unit extraction (FUE) are surgical techniques that have been proposed as treatments for inactive PCAs.
Aims:
This study aimed to evaluate the efficacy and safety of hair restorative surgery (FUE and FUT) for the management of PCAs.
Methods:
A systematic review was conducted to identify studies assessing treatment of a PCA in adults (≥18 years) with FUE or FUT. The primary outcome measure was graft survival. Secondary outcomes included postoperative complication rates and patient satisfaction. Proportional meta-analysis of graft was performed by using random-effects weighting.
Results:
Twelve observational studies with a total of 110 patients met inclusion criteria. The PCAs treated included frontal fibrosing alopecia (n=68), lichen planopilaris (n=37), folliculitis decalvans (n=1), coup de sabre (n=2), pseudopelade of Brocq (n=1) and central centrifugal scarring alopecia (n=1).
Overall, positive cosmetic results (defined as ≥85% graft survival post-transplant) were seen in 81.2% (95% CI 66.8-92.2%) of patients at 6 months, 78.5% (95% CI 62.1-91.3%) of patients at 12 months, 68.4% (95% CI 52.9-82.1%) of patients at 24 months and 32.7% (95% CI 8.9-62.7%) of patients at 48 months.
Conclusions:
FUE and FUT may be viable short-term treatment options for the management of inactive PCAs, with graft survival diminishing over time. However, this should be interpreted with caution due to risk of positive-publication bias and current evidence being limited to weak observational studies.