Hair transplantation for therapy-resistant alopecia areata of the eyebrows: is it the right choice?

Alopecia areata is a common skin disorder of presumed autoimmune etiology and it usually shows an unpredictable course. Treatment of alopecia areata is challenging. There is very little information on the use of surgical therapies for the treatment of alopecia areata in the medical published work. A 24-year-old male patient was referred to a private hair transplantation clinic owned by one of the authors for the treatment of therapy-resistant alopecia areata affecting both eyebrows. He had quickly lost all body hair 4 years prior beginning from the scalp. He received psoralen and ultraviolet A (PUVA) therapy for alopecia universalis and all body hair re-grew except his eyebrows. Alopecia areata was stable for the 18 months following the last medical treatment he received. Because there was no response to various medical therapeutic agents, we decided to transplant occipital hairs to the eyebrow area. After the patient understood and accepted all risks, occipital hairs were transplanted to the eyebrows by using the follicular unit extraction technique. Postoperatively, the patient did not receive any topical or systemic therapies for alopecia areata. Although 40% hair re-growth was detected in his eyebrows at 1 year postoperation, this rate was 80% by 2 years postoperation. However, there was resistance to re-growth in the medial eyebrow regions. New eyebrows grew as occipital hairs and required trimming. His satisfaction from the surgical procedure was 90% at the end of the 24th postoperative month. Surgical treatment of diseases like alopecia areata is still controversial. Our case report offers an additional contribution to the published work on the surgical methods used in the treatment of stable alopecia areata.

Effectiveness of non-ablative three dimensional (3D) skin rejuvenation: a retrospective study involving 46 patients.

BACKGROUND: Three dimensional (3D) skin rejuvenation is proposed to be effective for all skin layers. The aim of this concept is to treat sun spots with broad-band pulse light; large pores, fine lines and vascular lesions with a long-pulsed 1064 nm neodymium-yttrium-aluminum-garnet (Nd:YAG) laser system and skin ptosis and laxity with a 1100-1800 nm infrared light source. OBJECTIVE: In this study, 46 patients treated with the 3D skin rejuvenation procedure were retrospectively evaluated to assess the effectiveness of the 3D procedure according to both patient and doctor satisfaction. METHODS: The 3D procedure was carried out over the course of five sessions with 15 day intervals between sessions. Results were judged by an experienced laser dermatologist both by direct patient examination and by comparison of "before" and "after" photographs. Results were ranked into five categories ranging from 0 to 4. At the final control, the patients were also asked to rate their satisfaction with the procedure in five categories, ranging from 0 to 4. RESULTS: All of our patients showed improvement, with an overall patient satisfaction score of 2.65. Female patients were more satisfied than male patients. Patient and doctor satisfaction scores were generally correlated. CONCLUSIONS: Our clinical results indicate that the 3D procedure is an effective nonsurgical skin rejuvenation method.

Clinical experience in the treatment of different vascular lesions using a neodymium-doped yttrium aluminum garnet laser.

BACKGROUND: A neodymium-doped yttrium aluminum garnet (Nd:YAG) laser has been used with good results for the treatment of various vascular lesions. OBJECTIVE: To report our experience with a variable long-pulsed Nd:YAG laser for the treatment of different vascular lesions. MATERIALS AND METHODS: One hundred ten patients with different vascular skin lesions were included. Patients were examined before the treatment; 1 week after each treatment session; and 1, 2, and 3 months after the last treatment session. Improvement was judged according to clinical examination of the patients and by comparing pre- and post-treatment photographs. Results were graded in four groups using percentage resolution (0-25%, 26-50%, 51-75%, and 76-100%. RESULTS: One hundred five patients (19 port wine stains, 48 telangiectasias, 25 hemangiomas, and 13 other vascular lesions) completed the study; 71.5% of patients showed greater than 50% improvement. Good to excellent (more than 50%) results were achieved in 63.2% of patients with port wine stain, 80.0% of patients with hemangioma, 66.7% of patients with telangiectasia, and 84.6% of patients with other vascular lesions; 71.5% of all patients were very satisfied or satisfied with the results. CONCLUSION: A variable long-pulsed Nd:YAG laser was found to be effective in the treatment of different vascular lesions ranging from easy to difficult to treat. The authors have indicated no significant interest with commercial supporters.