Hair Transplants in patients with Psoriasis

[Dr Arvind]

Dear forum readers,
A question asked sometimes by prospective patients is
--- Can they undergo a hair transplant if they have Psoriasis?

Will the surgery lead to a spread of the psoriatic lesions?
If body hair grafts are used, will the cuts lead to flaring up of psoariasis in that area?

We have performed hair transplants for quite a few patients, who also happened to be suffering from Psoriasis.
However, I recently had an ocassion to meet and talk at quite some length to a past patient when he came for his repeat HT.
Talking to him, I felt that there must be countless other readers who may benefit from a recounting of this patient's experiences and an in depth discussion. I would request readers to post their queries in regards to psoriasis and hair transplants and we will try to answer them.

Some informative resources about Psoariasis: http://www.psoriasis.org/home/, http://www.nlm.nih.gov/medlineplus/psoriasis.html
________________________________________________________________________

Psoriasis
Psoriasis is a fairly common skin disorder.
The commonest form of Psoriasis (Plaque psoriasis) is characterized by patches of red skin covered with silvery scales and inflammation.
The most frequent areas where these patches are found are the knees and elbows.
However, they may also be found on the arms, legs, trunk, or scalp. In fact almost any part of the skin.

Psoriasis are more common in the Caucasian population. However, they are known to occur in all races. In fact, the patient I refer to on this post is of Indian descent.

The true cause of Psoriasis is not known. Autoimmune influences are suspected. There seems to be a genetic predisposition and often many members of the same family are afflicted by it.

However, Psoriasis is not contagious.

Physical injury is said to be one of the factors that may cause a flaring up of the psoriatic lesions, and for purpose of hair transplants, including body hair transplants, that is the relevant concern.
Below are 2 pictures that shows what typical Psoriatic patches look like.

The first is the trunk (chest and abdomen).

The second is the knee and shin area.

While Psoriatic attacks are not difficult to control (topical sterois, UV exposure etc.), most patients prefer to limit the areas of these patches.

The patient's concern was with what we, in medical terms, refer to as Koebner reaction.
Psoriasis patients commonly notice that new areas of psoriasis occur within 7-10 days after the skin has been injured. This has been called the Koebner reaction.

While performing hair transplants, therefore, the patient had the following concerns -

1. Should a strip procedure be performed if the scalp donor area has psoriatic patches with its attendant temporary hairloss?
2. Will the needle incisions in the recipient area lead to new psoriatic patches in that area (where none were before)?

2. BHT - whether the needle cuts used for extracting body hair grafts lead to any escalation of psoriatic patches?

Regards,
Dr. A

 

[Bigmac]

Great post Dr Arvind.
Thanks for sharing it.
Bm.

 

[Dr Arvind]

Scalp Psoriasis and strip FUHT procedures

Psoriatic patches, most commonly, develop in the back of the scalp (donor area), though may occur as discrete patches in almost any part of the scalp.

Please remember scalp Psoriasis does not cause permanent balding. However, it may lead to a temporary hair shedding in the psoriatic patches. Upon remission, the hair grow back in those plaques.

When planning a scalp to scalp HT, its prudent to first treat any Psoriatic patches. That is very important if the person is opting for a strip FUHT procedure and has a psoriatic patch in the scalp donor area. Excising a strip in such case would amount to donor wastage.

FUSE/fue method, can be performed as only the visible hair will be cherrypicked.





Its best to go for a hair transplant procedure once the psoriasis is under control in the donor areas.

Regards,
Dr. A

 

[Aafreen]

Dr Arvind , what can the patient do if they suffer a breakout of Psoriasis in the transplant receiving area soon after?

 

[Dr Arvind]

Dear Aafreen,

Treatment of psoriasis in the scalp presents its own unique problems.
1. The hair covering the psoriatic plaques, prevent adequate sun exposure. Sunlight exposure, in form of UV light, is a known treatment for Psoriasis.

2. The presence of hair make application of many topicals difficult and messy.

3. Scalp psoriasis may be overlapped by seborrhoeic dermatitis.


Scalp care -
Keeping the above things in mind, the following is a suggested scalp care regimen.
1. Go for a buzz cut, if possible. That will help by more UV exposure to the affected area and will make application of topicals easier.

2. Coal tar and Ketoconazole shampoos. Remember that medicated shampoos need to be massaged into the scalp and left in for a longer time. We recommend that you wet your hair first, apply the shampoo and leave it on for 10 minutes before rinsing it off.

Coal tar shampoos are sufficient starting treatment for most scalp psoriasis patients. Ketoconazole can be added if the psoriasis is accompanied with seborrhoeic dermatitis (also called sebo-psoriasis) and/or fungal infections.

Use these shampoos twice a week. For people who do not like the smell of these medicated shampoos, post bath, they can shampoo again with a non medicated shampoo of their choice, followed by a conditioner. That should take care of the smell issue.

For those suffering from more severe psoriasis, use of topicals may be required.
Topicals may be in form of steroids (Diprovate lotion is easier to apply as it is alcohol based instead of cream/oil base) can be used to alleviate the itching. Prolonged use of steroids should, however, be avoided. Its best to use them intermittently.

Coal tar creams, salicylic acid creams and Coconut oil compound ointment are more effective (though messy). Apply these creams by rubbing them into the plaques. Wait for 1 hour and then shampoo them out. Or, apply them before bedtime and leave them overnight. Wash the next day.

Resistant or difficult to treat psoriatic patches may require Dithranol,
Calcipotriol, phototherapy and oral medications.

Please remember that all treatments mentioned above must be taken under proper medical supervision.

Regards,
Dr. A