Hair Restoration Blog

Q:

Hi doctor, I had synthetic hair transplantation last year. After a few months following the starting process, several complications started to appear such as, blistering, infection, folliculitis and a currently very red scalp. I finally had to yank out nearly all the transplanted artificial hairs, but there is still severe redness as well as a demarcated line on my scalp with some blistering and diffuse atrophy of my scalp skin. Where do I go from here? Do you have any recommendations from this point?

With thanks,

An unhappy synthetic hair recipient,

A:

Synthetic hair is known for its problems including infection, severe skin contact reaction and inflammation of scalp that may occur after their use.  We discussed artificial hair implantation in this blog before.  If you removed them, it is likely that the rest will fall off too.  Do not manipulate your scalp and your skin inflammation should improve with time.  The FDA has never approved artificial hair for their hair transplant use in the United States and hair transplantation through the use of a patients own hair is the gold standard for hair replacement surgery.  Below, you can see a summary of an article on artificial hair and its consequences from the Indian Journal of Dermatology.(1)

Implant or transplant

At the outset, it is important to distinguish between implants and transplants of hair.  In contrast to transplants that use patient’s own hairs, usually taken from the occipital area, implants indicate the implantation of prosthetic hair fibers just as artificial hair implantation does.

There are two types of prosthetic hair:

1. Synthetic fibers (such as monoacrylic, polyacrylic, and polyester)
2. Natural fibers (such as processed human hair).

They are implanted into the galea (which is the fibrotic layer underneath the skin and fat layer under that) by use of a knot through an implanter device. The advantages claimed with this technique are the relative ease of the procedure, which can be learned in a few days, relatively bloodless technique, and immediate cosmetic result. In contrast to transplants however, these fibers do not grow and hence cannot be cut or shaven. In this respect, they resemble a wig, which has been fixed permanently to the scalp.

Problems with synthetic hairs

These fibers have had a checkered history. First introduced in 1970s, they soon became the subject of much controversy because of their numerous complications including recurrent infections, rejection, periodic loss of fibers needing frequent replacement, frequent allergic reactions leading to severe contact dermatitis, irritant effects, fears about carcinogenicity, cicatricial alopecia, granulomatous hypersensitivity, and cyst formation.

In 1983, the US Federal Drug Administration banned the fibers for the following reasons:

1. The fibers presented risks of illness or injury owed to the non-biocompatibility of the fibers and non-medical performance of the implant.
2. The fibers presented fraud owing to the following:
   • Deceptive information on the efficacy.
   • Inadequate information on risks from implant.
   • They did not show any benefit for public health.

The ban on prosthetic hair fibers is established in Section 895.101 of Code 21 of Federal regulations of the FDA, title 21, vol. 8, revised as of April 1, 2004.

Reference:
1. Mysore V. Synthetic hairs: Should they be used?. Indian J Dermatol Venereol Leprol 2006;72:5-7

Cicatricial alopecia refers to a group of rare skin diseases in which hair follicle get destroyed and replaced by scar tissue. It is one of the rare causes of hair loss. Hair loss could be gradual or sudden. Hair loss could be without any symptoms or it could present with sever itching, burning and pain. There is usually no visible scar, because the inflammation is below the level of skin. Cicatricial alopecia could occur in otherwise healthy men and women of all ages.

Cicatricial alopecias could be primary or secondary. This discussion is confined to the primary cicatricial alopecias in which the hair follicle is the target of the destructive inflammatory process. In secondary cicatricial alopecias, a non-follicle-directed process or external injury, such as severe infections, burns, radiation, or tumors could cause destruction of the hair follicle.

The causes of the cicatricial alopecias are not completely known. However, all cicatricial alopecias involve inflammation directed at the hair follicle, the upper part of the follicle where the stem cells and sebaceous gland are located are generally involved. Permanent hair loss occurs when the stem cells and the sebaceous glands are destroyed. This type of hair loss is usually irreversible.

Cicatricial alopecias can affect both men and women. The majority of patients with cicatricial alopecia have no family history of a similar condition. Central centrifugal cicatricial alopecia is a type of cicatricial alopecia that is more prevalent among black woman. Frontal fibrosing alopecia on the other hand is seen most commonly in post-menopausal women and could be seen in association with chronic skin conditions such as lupus erythematosus and in people with personal or family history of autoimmune disorder. A scalp biopsy is necessary for diagnosis of cicatricial alopecia. Presence of inflammatory cells and scarring could be diagnostic and essential for determining the type of treatment.

Treatment of the lymphocytic group of cicatricial alopecias involves use of anti-inflammatory medications such as steroids, cyclosporine, hydroxychloroquine. When hair follicle destroyed, hair will not grow back. However in some cases using minoxidil solution can help to stimulate growth of some of the remaining hair.

Hair transplant could only be used in the patients who have normal healthy hair on donor area without any microscopic or macroscopic evidence of cicatricial alopeica activity.  If hair multiplication becomes a reality it might potentially be a good option for patients who lost their scalp hair extensively as result of cicatricial alopecia.