Transplantation of Hair Bulbs and Melanocytes into Leukodermic Scars

PHILIP LOBUONO, M .D ., AND HARRY SHATIN, M.D.

In performing transplantations o f hair into places scarred and depigmented by discoid lupus erythematosus, it was found that considerable repigmentation in addition to growth o f viable hairs was achieved.

o f h a i r was feasibly developed by Orentreich1 and others in the 1950’s, and by now is a common and popular procedure for male-pattem and other forms of alopecia. In recent years, it has been repeatedly shown that such transplantations can be successfully ac­ complished in alopécie areas caused by conditions such as traumatic and surgical scars, pseudopelade, deep pyoder­ mas of the scalp, lichen planopilaris, discoid lupus erythematosus, and radiodermatitis. ^3 Very little, however, has been reported on repigmentation of leukoderma as­ sociated with correction of scarred alopecia. We herewith report a favorable result in the form of re­ pigmentation in addition to transplantation of hair in a case of discoid lupus erythematosus.

T r a n spl a n t a t io n

C A SE REPORT

A 46-year-old black man with discoid lupus erythermatosus of some years’ duration had an irregular patch of From the Dermatology Section, Veterans Administration Hospital, Bronx, N .Y ., and Mt. Sinai School o f Medicine o f the City University o f New York. Requests for reprints should be sent to the Dermatology Section, Veterans Administration Hospital, Bronx, N .Y . 10468.

leukodermic alopecia that measured about 10 by 6 cm. (see Figure 1). The defect involved the frontal and parietal areas in a particularly disagreeable cosmetic way. When the dis­ ease process was no longer active, transplantation of tissue from unaffected places of the scalp was undertaken. In the course of three months, 51 plugs were placed into the alopecic site secundum artis. Hair regrew in time and repigmentation could be seen to begin and progress satisfac­ torily and confluently into adjacent areas. DISCUSSION

The significance of our experience is that melanocytes as well as hair bulbs are transplantable and remain viable. It seems too that the less atrophic the leukodermic scarring, the better the possibility of repigmentation and regrowth of hair. In our case, the discarded plugs from the affected area appeared to be nearly as robust as those taken for transplant from the healthy area. The remaining question is: do melanocytes migrate or do melanin merely disperse from the plugs of healthy tissue into neighboring leukodermic areas? The phenomenon of repigmentation of leukodermic areas via grafts from nor­ mally pigmented areas has been long known,4*5 but whether

J o f Derm Sur g 2:1 March 1976

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TRANSPLANTATION OF HAIR BULBS AND MELANOCYTES

FIGURE 1. Area o f cicatrical alopecia p rio r to treatment.

FIGURE 2. Treated area 12 weeks after initiation o f trans­ planting. Note the significant pigment migration from the first set o f transplanted plugs.

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J o f Derm Surg 2:1 March 1976

LOBUONO AND SHATiN

it was by migration of melanocytes or dispersion of melanin was not settled until much later. Lewin and Peck6 and Billingham and Silvers7’8 in trans­ plantation experiments with prebald guinea pigs, and Orentreich,9 in a patient with intractable, persistent postinflammatory leukoderma, proved that melanocytes actually mi­ grate from transplants and repopulate adjacent sites that lack them. In short, tissue-bearing healthy hair bulbs and melano­ cytes, when successfully transplanted, provide continued local growth of the transplanted hair bulbs and persistent function and considerable spread of the transplanted melanocytes. REFERENCES

FIGURE 3. T reated area 18 weeks after transplantation was instituted.

1. Orentreich, N: Autografts in alopecias and other selected dermatological conditions. Ann NY Acad Sei 83:463-479, 1959 2. Stough, DB, Berger, RA, Orentreich, N: Surgical im­ provement of cicatricial alopecia of diverse etiology. Arch Dermatol 97:331-334, 1968 3. Norwood, OT, Hair Transplant Surgery, C.C. Thomas, Springfield, 111., 1973, pp. 92-93 4. Carnot, P, and Deflandre, C: Persistance de la pigmentation dans les greffes epidermigues. Comptes rendus des seances et mem. de la Soc Biol 48:178-180, 1896 5. Loeb, L: Veber Transplantation von weisser Haut auf einen Defekt in schwarzer Haut und Umgekehrt am Ohr des Meer­ schweinchens. Arch f Entw Mech der organisem 6:1-45, 1897 6. Lewin, ML, Peck, SM: Pigment studies in skin grafts on experimental animals. J Invest Dermatol 4:483-504, 1941 7. Billingham, RE, Stivers, WK: Further studies on the phe­ nomenon of pigment spread in guinea pigs’ skin. Ann NY Acad Sei 100:348-363, 1963 8. Billingham, RE, Silvers, WK: Studies on the migratory be­ havior of melanocytes in guinea pig skin. J Exp Med 131:101-117, 1970 9. Orentreich, N, Selmanowitz, VJ: Autograft repigmentation of leukoderma. Arch Dermatol 105:734-736, 1972

FIGURE 4. Treated area 10 months after transplantation was begun. Note the complete repigmentation o f the areas initially treated.

J o f Derm Surg 2:1 March 1976

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Transplantation of hair bulbs and melanocytes into leukodermic scars.

Transplantation of Hair Bulbs and Melanocytes into Leukodermic Scars PHILIP LOBUONO, M .D ., AND HARRY SHATIN, M.D. In performing transplantations o...
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