Clinical Evaluation of Pressure Alopecia

Lee, Deborah; Kang, Mi Seon; Lee, Sang Seok; Cho, Si Hyung; Park, Sung Wook

Abstract

BACKGROUND
Pressure alopecia is the loss of hair following a prolonged immobilization, probably due to pressure-induced local ischemia. It is most commonly observed after surgical procedures under general anesthesia. Most of the studies or reports of pressure alopecia deal with postoperative cases. OBJECTIVE: This study was undertaken to investigate and understand the clinical manifestations, course and histopathological characteristics of pressure alopecia in various circumstances. METHOD: 27 patients with pressure alopecia, who had visited the Department of Dermatology at Busan Paik Hospital between 1998 and 2004, were examined clinically and histopathologically. RESULTS: The ratio of males to females was 4: 5, and the mean age of patients was 36+/-22 years. The cause of pressure alopecia were classified into 5 groups: open heart surgery, craniectomy, other surgeries, long-term bed rest, and the miscellaneous causes including wearing of hair prosthesis and group punishment. The most commonly involved site was the occipito-parietal area. Histopathological examination showed upper dermal edema and fibrosis, follicular fibrosis, melanin pigments, hair follicles in telogen and catagen stages, perifollicular lymphocytic infiltration and vascular change. The mean operation time was 8.1+/-7.2 hours in the patients with temporary alopecia and 17.8+/-7.6 hours in those with permanent alopecia. The mean operation time of the patients with temporary alopecia was shorter than those with permanent alopecia (p<0.05). CONCLUSION: This study revealed several causative factors of pressure alopecia including surgery, long-term bed rest, and miscellaneous causes. Therefore, close observation of the pressure site and changing the position of the patient's head at regular intervals are essential during the various surgical and nonsurgical treatments to prevent pressure alopecia.