Authors : Dr. Ravi K Bhushan .
 

Case History:

37 yr male presented with baldness (NW grade 3) with atrophic plaque extended from left eye brow to frunto-parietal of scalp for last 5 yr.
   

Investigation:-

• Skin biopsy :

inflammatory infiltrate absent , Collagen bundles thickness present.
   

Imaging (X-rays and MRI Skull) :-

Normal
 

Differential Diagnosis:-

Scleromyxedema
Lipodermatosclerosis
Linear lupus erythematosus panniculitis
Parry-Romberg syndrome (PRS)

 

Diagnosis:-

On the bases of History, Investigation And Differential diagnosis Made Diagnosis of Linear Scleroderma en coup de sabre with non active state .
 

Treatment:-

Pt was only concerned with hair loss so we decided to transplant hair after routine investigations.
 

Method:-

We used FUE technique (Direct Hair Transplant) and transplanted total 1500 grafts (1000 from scalp + 500 from beard).
 

Prerequisites for doing FUE

Adequate experience and training of the surgeon

 

ADEQUATE O.T. Temp & ERGONOMIC FURNITURE

 

INNOVATIVE INSTRUMENT / METHOD

 

FUE STEPS;-

• PREPARE DONOR AREA (SHAVE / CLIP)


• ANTERIOR HAIRLINE DESIGN


• INFILTERATE SUBCUTANEOUS TISSUE


• SLIT CREATION


• GRAFT DISSECTION

1. ALIGN THE PUNCH


2. ENGAGE THE PUNCH


3. ADVANCE THE PUNCH

• REMOVAL OF GRAFT FROM SCALP & PLACEMENT


• REMOVAL OF GRAFT FROM BEARD & PLACEMEN

 

Picture of Procedure & Result

Just before hair transplant	Just after hair transplant (1500 graft)

 

Conclusion:-

When coup de sabre is no longer in an active state, hair transplantation is a useful method for cosmetic improvement of the alopecia.

Eight month follow-up studies showed an 86 % survival rate of the transplanted hairs and significant improvement in dermal depression
 

3 week after (1500 graft)	3 month after (1500 graft)	8 month after(1500 graft)

 

References:-

1. ( Dermatol Surg. 2002 Aug;28(8):763-6; discussion 766-7 , Park SW , Wang HY)
2. Scarring alopecia research foundation. Available at: http://www.carfintl.org/faq .Accessed on March 3,2009.
3. Ross EK,Tan E , Shapiro J. Update on primary scarring alopecias. J Am Acad Dermatology 2005;53:1
4. Hermes B, Paus R. Scar forming alopecia. Comments on classification, differential diagnosis and pathobiology. Hautarzt 1998;49:462
5. Sterry W, Paus R, Burgdorf W. Dermatology, Thieme Clinical Companions, Thieme, Stuttgart. New York, 2006
6. Hairdoc weblog. Hair transplant srugeon and male pattern baldness. Available from http://hairdoc.wordpress.com/2008/04/03/treatment-of-scarring-alopecia. Accessed on March 6,2009.
7. Li AL, Yu MS, Yan YZ. Treating Cicatrical baldness with scalp expanding and hair autografting. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2001;15:99-100. [PUBMED]