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Lichen Planopilaris After Hair Transplantation and Facial Surgical Procedures: A Systematic Review
Jorge Lázaro Escudero1, June Y Moon2, Jacob Fiedler2
1Department of Medicine, Hospital Universitario Dr. Ramón Ruiz Arnau, Universidad Central del Caribe, School of Medicine, Bayamón, Puerto Rico.
Background:
Lichen planopilaris (LPP) is a rare cicatricial alopecia characterized by perifollicular inflammation and progressive scarring hair loss. Case reports suggest a temporal association between facial and scalp surgical procedures and LPP development, though the literature remains fragmented.
Objective:
To characterize published cases of LPP, including frontal fibrosing alopecia, occurring after hair transplantation or facial surgical procedures.
Methods:
A systematic review was conducted using PubMed and Cochrane Library databases from inception through March 2023 following PRISMA guidelines. Given the study design heterogeneity, findings were synthesized qualitatively. Studies reporting new-onset LPP after scalp or facial procedures were included.
Results:
Seven studies comprising 66 patients met inclusion criteria: 34 after hair transplantation and 32 after facial procedures. The mean age at diagnosis was 55.7 years, younger than the general LPP population. The mean latency from procedure to disease onset was 4.88 years. Lichen planopilaris developed at transplant sites in all cases with available localization data, with 44% demonstrating additional distant involvement.
Conclusion:
Surgical trauma to face and scalp may serve as a trigger for LPP in predisposed individuals, although a causal relationship remains unestablished, and subclinical LPP may have predated the procedure in some patients. Clinicians performing these procedures may consider discussing this rare complication.
