I have dermal fibrosis as a result of Folliculitis Decalvans in vortex region. Will a transplant work in scalp with fibrosis?

Hair transplant surgery is generally contraindicated in scarring type of alopecia. You need to see your doctor for the correct diagnosis and treatment planning.

vellus1,Thank you for this interesting question.The successful surgical treatment of patients with dermal fibrosis resulting from folliculitis decalvans or any scarring alopecia varies among patients. It is essential that surgical treatment be timed appropriately at the time at which there is no inflammatory activity at the level of the sweat glands. Scalp biopsies should be taken and sectioned vertically and horizontally and read by a good dermato-pathologist. Surgery should only be attempted one year after no disease activity as documented by scalp biopsy. The success is dependent also on extent of scarring. Test grafting of a small number of grafts would not be a bad idea. If the test grafting is successful, then larger sessions can be entertained but the surgeon needs to monitor the bleeding in the receptive area as this is indicative that the perfusion of the tissue is adequate. Kind regards,Bernardino A. Arocha, MD

For Folliculitis Decalvans, I hope that you are under the care of a good dermatologist. This tends to be a an unrelenting chronic condition that can come and go without any predictability and unfortunately can leave devastating scarring patches of baldness in it's wake.  That being said, if the disease appears "burned out," meaning that there has been no progression, no redness, no pustular areas, etc for over a year then you may consider consulting for a hair transplant. The survival of the hair transplant depends on many things.  First of all, you can't transplant hairs/grafts as densely into scars as you can the normal scalp. You need good blood flow to the new growing grafts so you have to leave more room in between for them in the scar area. This makes the transplanted area thinner then may be desired.  Also, the disease may flare up after the transplant, which will reduce the survival of the grafts. Any subsequent flares need to be treated immediately and aggressively to prevent loss of native hair and transplanted hairs.  You will need to have continuous and close follow up with your dermatologist or your hair transplant surgeon (if she does both) in order to stay on top of this in the months and years to come after a hair transplant.

I have had a few patients with this condition and it is very difficult to do successful transplants that don't get infected. Eventually the infection goes away and the transplants succeed, but this is no easy process. My last patient took over 1 year to treat the infection and he was a doctor.