Can those with behcet's disease have a FUE hair transplant?

Question

Aged 25 and on colchicine, can I still get a hair transplant? 2000-3000 grafts.

Jeff Donovan, MD, PhD · Answer

Thanks for the question. The key here is to realize this is not simple - and there is no simple answer. For some surgeons, the answer is “no.” For others it is “maybe.”

There are many different presentations of Behcet’s disease so not everyone is the same. Some patients have gastrointestinal and neurological involvement and some don’t. Some have mild disease and some have severe disease.

It’s important to realize that some patients with Behcet’s disease demonstrate “pathergy” meaning there is a tendency for the skin to become inflamed with any kind of trauma. FUE is of course a type of “trauma” and so are the recipient area incision sites. There is a real possibility of poor growth, skin pustular inflammation, infection, bleeding and even activation of multisystem involvement (joints, gastrointestinal, eyes, neurological).  It’s so critical to realize how complicated this can rarely be. That is why this is actually a very tough question. What is challenging is that these side effects don’t happen in everyone. There are many factors that go into a decision to say a hair transplant surgery might be okay. It’s not simple so be sure to connect with a good dermatologist if you have not already and with a good rheumatologist. My own advice for patients my patients is to have a “pathergy” test on the forearm every 4 months for 3 times. At each visit, 6 individual pokes with a 20 gauge needle should be performed. If all those are “negative” over the 12 month period then that is a good sign. If any are positive, then surgery is not likely to be a good idea at all. If there have been significant skin lesions of Behcet’s so far in the disease course, this would not be a super favourable sign for giving the go ahead to surgery. Other factors that sway me more towards feeling this might be at least “possible” to consider are: a)  CRP and ESR blood test levels are normal for at least 2 years b) patient had “mild” Behcet’s disease at presentation and now has completely inactive disease c) the patient never had involvement of the joints or nervous system at any point in the disease d) patient responded well to steroids in the past e) patient is currently on immunosuppressants and is under care of a rheumatologist and f) patient has successfully undergone some type of minor surgery or minor procedure in the past few years (dental surgery, wound laceration repair). This final criteria is not mandatory but is a definite bonus if a patient tolerated such surgery or procedure with no issues. Finally, if all of these prior criteria suggest it might be possible then a 100 FUE graft “test procedure” should be done with monitoring of complications for a full year (as well as hair growth). I review with the rheumatologist if we can give prednisone during the perioperative period or not. Generally this is 40 mg daily for 3 days and 20 mg for 3 days and 10 mg for 3-7 days. Not all physicians agree to the plan so each patient needs to review on a case by case basis. One needs to review antibiotic use as well on a case by case basis. If there are no complications with the test procedure then I might be inclined to say a bigger procedure is possible assuming all the factors above remain true (ie no Behcet’s disease reactivation, no skin reactions, no flare of disease). All in all, this is a very complicated scenario and requires careful planning and careful thought. It is not always possible to have a hair transplant with Behcet’s disease that is for sure. However, there are exceptions and in cases if mild disease that responded extremely well to therapy and show no signs of pathergy and responded really well witha test procedure, this may be possibly on a case by case basis. Be sure to review fully with all your providers.

George Abrahamian, MD · Answer

Hello, Dr. George Abrahamian MD here, from La FUE Hair Clinic, Pasadena, CA. It would be highly recommended to receive a medical clearance from your primary physician and/or rheumatologist/immunologist prior to pursuing hair transplant surgery. Behçet's disease is an inflammatory disease that affects blood vessels, which are very important during the recovery process after a hair transplant. If the Behçet's disease is well controlled, then you should be in the clear to have a hair transplant, but if there is an active flare, then it should be controlled prior to transplanting. If the concern is colchicine use and hair transplant, there is no contraindication, and many patients on colchicine have received successful hair transplants. 
I hope this helps, best of luck with your hair restoration journey!

Farhanahmed Contractor, DO · Answer

Hair Restoration by a FUE procedure is ideal for patients with Androgenetic Alopecia. I generally advise against patients who have Behcet's disease from having an FUE procedure especially those with extensive scalp involvement (e.g. patchy loss) given that chronic inflammation such as vasculitis or immunosuppressive therapy, may affect the success and safety of a hair transplant procedure. Before considering a hair transplant, it is crucial to ensure that the patient's Behçet's disease is well-managed and under control as the stress of an FUE procedure may exacerbate inflammation and worsen your condition.

Arslan Musbeh, MD - Account Suspended · Answer

Behçet hastalığı, oto-enflamatuar ve damarları etkileyen bir hastalıktır; bu nedenle yaraların iyileşmesi ve iltihap riskleri saç ekimi sonrası normalden farklı seyredebilir.
Yine de bu, saç ekiminin tamamen yapılamayacağı anlamına gelmez.
Durum aktif değilse, yani son aylarda atak veya ciltte lezyon görülmemişse, FUE saç ekimi dikkatli planlama ile yapılabilir.

Dikkat edilmesi gereken noktalar:

Kolşisin kullanımı genelde engel değildir; hatta iltihap kontrolüne yardımcı olur.

Ekim, hastalık en az 6 ay boyunca remisyonda (sakin dönemde) iken yapılmalıdır.

Operasyon mutlaka steril koşullarda ve deneyimli bir doktor gözetiminde gerçekleştirilmelidir.

PRP veya biyolojik uyarıcı içerikli mezoterapi uygulamaları, bağışıklık sistemini tetikleyebileceği için erken dönemde önerilmez.

Sonuç olarak, 2000–3000 greftlik FUE saç ekimi, Behçet hastalığı kontrol altında olduğu sürece mümkündür. Ancak işlem öncesinde mutlaka romatoloji veya dermatoloji uzmanından onay alınmalı, ekim ise bu tür özel vakalar konusunda tecrübeli bir hekim tarafından yapılmalıdır.

Bu cevap Dr. Arslan Musbeh tarafından onaylanmıştır.

Can those with behcet's disease have a FUE hair transplant?

Answers (4)

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