Can someone with autoimmune disease have a hair transplant?

Question

Hello, I have alopecia areata small patch that got resolved by kenalog injections. I also have male pattern baldness which I take finasteride. If I want to have a hair transplant to fix my male pattern baldness, will I be a good candidate since I have the auto immune genetic predisposition towards alopecia areata? By doing a hair transplant can that somehow trigger the immune to flare up alopecia areata somewhere on the scalp?

Anna Chacon, MD, FAAD · Answer

Alopecia areata is an autoimmune condition that causes hair loss in patches, usually on the scalp. It is important to note that this condition is fundamentally different from male pattern baldness, which is a hereditary condition characterized by thinning hair and a receding hairline.In the case of alopecia areata, the immune system mistakenly attacks hair follicles, leading to hair loss. Current treatments, like the kenalog injections you've received, aim to suppress the immune response and allow hair to regrow.For male pattern baldness, treatments like finasteride work by blocking the production of a hormone that causes hair follicles to shrink and eventually stop producing hair.Hair transplantation is a potential treatment for male pattern baldness. It involves moving hair follicles from one part of the scalp (the donor site) to the balding areas. The transplanted hair follicles are not typically affected by the hormonal changes that cause male pattern baldness, so they continue to grow hair in the new location.
However, in the context of an autoimmune disease like alopecia areata, there is a theoretical risk that the immune system could attack the transplanted hair follicles, leading to hair loss in the transplanted areas. Research on this topic is limited, and the actual risk may depend on various factors including the severity of your alopecia areata, the location and extent of the hair transplant, and other individual factors.
If you are considering a hair transplant, it would be important to have a detailed discussion with your dermatologist or a hair transplant surgeon. They can help you weigh the potential benefits and risks, and make an informed decision about the best treatment approach for your specific situation.

Kulakarn Amonpattana, MD · Answer

Dear Steven_gq,
Hello I'm Dr. Wipawan Vathananai, a co-worker of Dr. Kulakarn Amonpattana, from BHI Clinic, Bangkok, Thailand. Regarding your concern, it is likely that AA will be triggered after the hair transplantation because the immune system is triggered during the healing of the donor and recipient area. It could be just one small patch or even multiple patches scattering through the whole scalp which can cause anxiety for the patients.
AA is not an absolute contraindication for getting a hair transplantation. However, it will take more time for the hair to grow to the point where you can wear normal hairstyle if AA is triggered after the hair transplantation.

Best regards,Wipawan Vathananai MD

Matt Tahsini, MD · Answer

Hello, and thank you for your question.  There is no simple answer to your question since I am unaware of your medical background. Typically, you would not be a good candidate for a transplant. I think it's best that you speak to your doctor and determine if you would be a good candidate for a transplant.
Best of luck to you.
Dr. T

Jeff Donovan, MD, PhD · Answer

Thanks for the question. You are not a great candidate but you might still be a moderately good candidate. It just depends on your full story. If you have one patch and have not had another patch develop (on scalp or beard or eyebrow or body) after 2 years of close watching then it could be a possibility. You need to be aware that another patch may form and the next patch may be small or large and the next patch may respond to injections or it may not respond to injections. The next patch may occur 2 months from now or 2 years from now or 20 years from now or 60 years from now. There is roughly a 90 % chance you will have another episode in your life. All of this information needs to be reviewed in detail between you and your doctor. I generally recommend waiting 2 years to get a better sense if your alopecia will be more likely on the milder side or whether new patches will form in the near future. Hair transplants are possible for those with very very mild alopecia areata but only if the patient understands that 8 conditions are possible: 1) the patient understands the alopecia areata hair loss condition will likely come back sometime in the future but that could be a short time in the future or a very very long time in the future and 2) the condition can come and go many times in one’s life and patches of hair loss may regrow completely between “episodes” or there may be one or more scalp areas that do not regrow back completely between episodes 3) the condition may come back more severe or less severe next time if it does come back and 4) the hair loss may or may not respond to the same treatments (like steroid injections) next time and 5) it’s possible that other treatments are needed to regrow hair and some of these treatments may be lifelong daily treatments if one wishes to keep the hair and 6) in a very low proportion of patients it’s possible the hair loss will not respond to any treatment at all and 7)  in a very low proportion of patients develop total hair loss which would include loss of all transplanted hair and 8) loss of all hair in the case of advanced alopecia areata may reveal a scar from surgery or scarring (include FUE scars) from the procedure. Overall, successful hair transplants have been performed for many patients with mild episodic alopecia areata. But there is some degree of uncertainty about what will happen in the future. You and your doctors need to sit down together and review all these 8 principles and then you can decide if the risks are fairly low overall in your mind or too great. I suggest waiting a few years from the time of one’s first episode to get a better sense of what the alopecia areata will be like. Will it occur again every 4-6 months? Will ir occur every 4-6 years? Will it come back with small patches or large patches? Will it grow back with steroid injections or will it require daily lifelong immunosuppressant therapy with jak inhibitors or methotrexate to keep it growing?

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