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Successful Hair Transplantation of Recalcitrant Alopecia Areata of the Scalp

A 62-year-old male patient with a 4-year history of localized patchy AA affecting the scalp and eyebrows was referred to our office to be evaluated for hair transplantation. The patient had also previously been diagnosed with psoriasis and Hashimoto’s thyroditis with positive thyroid peroxidase antibody. The patient began experiencing scalp hair loss in 2003. A skin biopsy at that time revealed AA (severity rating of S3 and B1). 2 He was treated with multiple modalities, including topical, intralesional, and oral corticosteroids; 5% minoxidil solution; Anthralin; bexarotene gel; and imiquimod cream (Table 1). With treatment, his condition showed a gradual response except in 2 areas, which were completely resistant. Diphencyprone (DPCP) treatment was started in October 2003. After many months of DPCP therapy, without any response, a decision to stop treatment was made in February 2006. A repeat scalp biopsy performed in March 2006 in an area of resistant AA revealed the apparent replacement of hairs by fibrotic tracts, which were outlined by a condensation of elastic fibers. There were no inflammatory infiltrates present. The DPCP applications were tapered over the subsequent 6 months.