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"apellidos" => "Camps-Fresneda" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Department of Dermatology and Venereology, Curry Cabral Hospital, Central Lisbon Hospital Centre, Lisbon, Portugal" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Department of Dermatology, Catalonia General Hospital, Barcelona, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Teknon Medical Centre, Barcelona, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Trasplante de pelo en la alopecia fibrosante frontal: ¿parte de la solución?" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Primary cicatricial alopecias (PCA) are a diverse group of inflammatory hair disorders of unknown aetiology, clinically characterised by the loss of hair shafts, visible follicular ostia, and variable degrees of scalp inflammation. The hair follicle is the primary target of the disease process and persistent inflammation leads to irreversible damage to the hair follicle's stem cells. Ultimately, replacement of follicular structures by scar-like fibrous tissue occurs.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1–3</span></a> Frontal fibrosing alopecia (FFA) is one of the most common types of PCA. The clinical diagnosis is typically straightforward; FFA is considered to be a subtype of lichen planopilaris (LPP) and is based on similar histopathological findings.<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">4,5</span></a> An effective medical treatment remains elusive and evidence-based recommendations are weak: intralesional triamcinolone acetonide, finasteride, dutasteride, oral and topical corticosteroids (level of evidence D), and antimalarials (level of evidence E).<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1,5,6</span></a> Despite medical treatment, the course of FFA is uncertain and, in the best scenario, these drugs can only stop disease progression.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> In daily practice, we have observed that the cosmetic impact of FFA on women is a frequent cause of anxiety, and just halting the alopecia process is generally not sufficient in most cases. Some patients with FFA insistently demand a hair transplant despite being properly informed of the high risk of hair loss a few months after the procedure.</p><p id="par0010" class="elsevierStylePara elsevierViewall">How could hair transplantation be part of the solution for FFA? Literature regarding hair transplantation for FFA is scarce. Publications by Nusbaum et al. and Jiménez et al. report similar results: despite the growth of the hair shafts for 1.5–2 years after transplantation, more than 50% of the transplanted hairs had been lost after 3 years. Histological confirmation of FFA in the remaining transplanted follicles suggests that FFA displays recipient dominance. Post-transplant medical therapy is not mentioned in either of the publications.<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">6,7</span></a> Gurfinkiel et al. reported a successful case of hair transplantation in a female patient with FFA and vulvar lichen sclerosus with a follow-up of 6 years, maintaining systemic finasteride 1<span class="elsevierStyleHsp" style=""></span>mg/day and topical minoxidil 2% bid as post-transplant maintenance therapy.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Unger et al. have recently proposed two new categories of cicatricial alopecia: unstable and stable. Unstable cicatricial alopecias (UCA) have a tendency to progress and recur intermittently over the course of time, in either new or previously affected areas (e.g., discoid cutaneous lupus erythematous, LPP). Stable cicatricial alopecias are secondary to isolated events that cause permanent scarring in a hair-bearing region (e.g., burn, surgical scar); once successfully corrected surgically, there is no need for further therapy.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> The chronic and relapsing nature of FFA, even after hair transplantation, is the paradigm of UCA. It has become clear that this procedure can only be considered for FFA after a certain period of observation with no disease activity, and recommendations range from 1 to 5 years<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">6–8</span></a>; we do not usually consider hair transplantation in FFA until 2 years of clinical stability have been observed. However, once hair transplantation has been performed, these patients should be kept on maintenance medical treatment for affected areas, even if no clinical signs of disease activity are visible. The usefulness of performing trichoscopy to monitor disease activity and response to therapy cannot be emphasised enough: look for the presence of perifollicular hyperkeratosis/desquamation and perifollicular erythema, which are correlated with disease activity in FFA.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Regarding the maintenance medical treatment to be prescribed after hair transplantation for FFA, clobetasol propionate 0.05% lotion twice a week could be considered as a possible maintenance scheme; from our clinical practice experience, the risk of adverse effects with this regimen appears to be very small. As an alternative, a topical calcineurin inhibitor such as tacrolimus 0.1% ointment or pimecrolimus 1% cream could also be considered (tolerability: pimecrolimus<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>tacrolimus). In our experience, maintaining concomitant post-transplant therapy with systemic finasteride 5<span class="elsevierStyleHsp" style=""></span>mg/day and topical minoxidil 5% is also advisable, particularly if androgenetic alopecia is concomitantly present. Dutasteride has been recently attempted as an alternative to finasteride; although dutasteride might appear at least equally effective, its superiority and more favourable safety profile are not yet proven. Follow-up visits should be frequent, and more aggressive anti-inflammatory therapy must be initiated in case of clinical relapse, not only to “protect” transplanted hairs but also to prevent alopecia progression to previously uninvolved areas.</p><p id="par0025" class="elsevierStylePara elsevierViewall">To summarise, the need for post-transplant medical therapy for FFA is, in our opinion, absolutely decisive for the success of the transplantation. Prior to surgery, two requirements for FFA hair transplantation must be met: 2 years of clinical stability and the patient's commitment to follow-up visits and adherence to post-transplant medical therapy. Strong evidence-based recommendations for the medical and surgical treatment of FFA are warranted.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Management of primary cicatricial alopecias: options for treatment" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "M.J. Harries" 1 => "R.D. Sinclair" 2 => "D.A. Whiting" 3 => "C.E.M. Griffiths" 4 => "R. 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año/Mes | Html | Total | |
---|---|---|---|
2024 Noviembre | 3 | 1 | 4 |
2024 Octubre | 59 | 53 | 112 |
2024 Septiembre | 52 | 25 | 77 |
2024 Agosto | 63 | 65 | 128 |
2024 Julio | 67 | 22 | 89 |
2024 Junio | 83 | 57 | 140 |
2024 Mayo | 63 | 118 | 181 |
2024 Abril | 69 | 162 | 231 |
2024 Marzo | 45 | 155 | 200 |
2024 Febrero | 39 | 49 | 88 |
2024 Enero | 34 | 25 | 59 |
2023 Diciembre | 42 | 22 | 64 |
2023 Noviembre | 61 | 50 | 111 |
2023 Octubre | 52 | 33 | 85 |
2023 Septiembre | 62 | 25 | 87 |
2023 Agosto | 42 | 23 | 65 |
2023 Julio | 53 | 33 | 86 |
2023 Junio | 48 | 22 | 70 |
2023 Mayo | 56 | 32 | 88 |
2023 Abril | 59 | 65 | 124 |
2023 Marzo | 59 | 52 | 111 |
2023 Febrero | 68 | 18 | 86 |
2023 Enero | 59 | 31 | 90 |
2022 Diciembre | 71 | 48 | 119 |
2022 Noviembre | 63 | 43 | 106 |
2022 Octubre | 76 | 58 | 134 |
2022 Septiembre | 55 | 52 | 107 |
2022 Agosto | 57 | 54 | 111 |
2022 Julio | 51 | 58 | 109 |
2022 Junio | 33 | 43 | 76 |
2022 Mayo | 58 | 44 | 102 |
2022 Abril | 73 | 38 | 111 |
2022 Marzo | 79 | 68 | 147 |
2022 Febrero | 85 | 39 | 124 |
2022 Enero | 58 | 36 | 94 |
2021 Diciembre | 52 | 44 | 96 |
2021 Noviembre | 58 | 52 | 110 |
2021 Octubre | 121 | 57 | 178 |
2021 Septiembre | 67 | 42 | 109 |
2021 Agosto | 75 | 46 | 121 |
2021 Julio | 59 | 56 | 115 |
2021 Junio | 54 | 35 | 89 |
2021 Mayo | 49 | 33 | 82 |
2021 Abril | 79 | 82 | 161 |
2021 Marzo | 103 | 69 | 172 |
2021 Febrero | 100 | 44 | 144 |
2021 Enero | 51 | 41 | 92 |
2020 Diciembre | 61 | 41 | 102 |
2020 Noviembre | 42 | 40 | 82 |
2020 Octubre | 48 | 39 | 87 |
2020 Septiembre | 53 | 26 | 79 |
2020 Agosto | 44 | 44 | 88 |
2020 Julio | 40 | 34 | 74 |
2020 Junio | 32 | 50 | 82 |
2020 Mayo | 32 | 50 | 82 |
2020 Abril | 41 | 40 | 81 |
2020 Marzo | 32 | 47 | 79 |
2020 Febrero | 5 | 13 | 18 |
2020 Enero | 4 | 19 | 23 |
2019 Diciembre | 4 | 23 | 27 |
2019 Noviembre | 4 | 18 | 22 |
2019 Octubre | 0 | 15 | 15 |
2019 Septiembre | 0 | 25 | 25 |
2019 Agosto | 6 | 14 | 20 |
2019 Julio | 4 | 26 | 30 |
2019 Junio | 4 | 17 | 21 |
2019 Mayo | 5 | 24 | 29 |
2019 Abril | 3 | 6 | 9 |
2019 Marzo | 2 | 5 | 7 |
2019 Febrero | 0 | 2 | 2 |
2019 Enero | 3 | 2 | 5 |
2018 Diciembre | 2 | 6 | 8 |
2018 Noviembre | 9 | 3 | 12 |
2018 Octubre | 58 | 1 | 59 |
2018 Septiembre | 9 | 0 | 9 |
2018 Marzo | 1 | 0 | 1 |
2018 Febrero | 22 | 3 | 25 |
2018 Enero | 32 | 8 | 40 |
2017 Diciembre | 8 | 8 | 16 |
2017 Noviembre | 1 | 5 | 6 |
2017 Octubre | 6 | 5 | 11 |
2017 Septiembre | 13 | 6 | 19 |
2017 Agosto | 13 | 10 | 23 |
2017 Julio | 21 | 8 | 29 |
2017 Junio | 17 | 13 | 30 |
2017 Mayo | 13 | 12 | 25 |
2017 Abril | 15 | 18 | 33 |
2017 Marzo | 11 | 22 | 33 |
2017 Febrero | 9 | 8 | 17 |
2017 Enero | 9 | 8 | 17 |
2016 Diciembre | 12 | 22 | 34 |
2016 Noviembre | 13 | 27 | 40 |
2016 Octubre | 12 | 32 | 44 |
2016 Septiembre | 0 | 2 | 2 |
2016 Agosto | 0 | 1 | 1 |
2016 Julio | 4 | 10 | 14 |
2016 Junio | 1 | 7 | 8 |