Folliculitis, perifollicular inflammation, or what ?

[Eli_Avdikian]

I had a hair transplant in the frontal third in 2022. I'm set to have a second one at the end of this year. However, I still feel some mild stifness and pain in the recepient zone. Microscopic images show redness at the root of some hair follicles. I consulted a dermatologist who told me there's nothing to worry about. Nevertheless, I'm still very concerend, thinking that there's a serious condition that might affect the results of my second transplant 

 

Edited March 26 by Eli_Avdikian

[Dr. Wipawan Vathananai]

Hello,

Based on the photos provided, I can observe perifollicular scales, scalp redness, and moderate hyperkeratosis (the white desquamation). My initial diagnosis would lean towards seborrheic dermatitis, judging solely from these images. However, to ensure an accurate diagnosis, a physical examination and microscopic examination should be conducted in conjunction.

While there are no studies indicating whether seborrheic dermatitis affects graft survival in hair transplantation, it is not considered a contraindication. From my  experience, I haven't encountered any issues with graft survival. However, if the donor hair carries seborrheic dermatitis, it's possible for the recipient site to develop the condition as well once the hair starts growing. Seborrheic dermatitis isn't a dangerous condition, but it's not entirely curable either. Its occurrence can be influenced by factors such as weather, stress, and scalp hygiene. Perhaps seeking a second opinion from another dermatologist would be beneficial in obtaining an accurate diagnosis.

I hope this information proves helpful.

Best,

Wipawan Vathananai

Hair transplant surgeon & Dermatologist

BHI Clinic, Bangkok, Thailand

[Eli_Avdikian]

3 minutes ago, Dr. Wipawan Vathananai said:

Hello,

Based on the photos provided, I can observe perifollicular scales, scalp redness, and moderate hyperkeratosis (the white desquamation). My initial diagnosis would lean towards seborrheic dermatitis, judging solely from these images. However, to ensure an accurate diagnosis, a physical examination and microscopic examination should be conducted in conjunction.

While there are no studies indicating whether seborrheic dermatitis affects graft survival in hair transplantation, it is not considered a contraindication. From my  experience, I haven't encountered any issues with graft survival. However, if the donor hair carries seborrheic dermatitis, it's possible for the recipient site to develop the condition as well once the hair starts growing. Seborrheic dermatitis isn't a dangerous condition, but it's not entirely curable either. Its occurrence can be influenced by factors such as weather, stress, and scalp hygiene. Perhaps seeking a second opinion from another dermatologist would be beneficial in obtaining an accurate diagnosis.

I hope this information proves helpful.

Best,

Wipawan Vathananai

Hair transplant surgeon & Dermatologist

BHI Clinic, Bangkok, Thailand

Thanks a lot doctor! I highly appreciate your response

[Eli_Avdikian]

What kind of treatment would you usually prescribe for seborrheic dermatitis?

[Dr. Wipawan Vathananai]

2 minutes ago, Eli_Avdikian said:

What kind of treatment would you usually prescribe for seborrheic dermatitis?

You can try these products;

- Ketoconazole shampoo

- Tar shampoo

- Selenium sulfide or Selenium disulfide shampoo

- Clobetasol shampoo (severe cases)

- Topical desoximethasone (moderate cases)

For the shampoo, please use it every 2 days in the beginning and make sure you leave it on your SCALP for at least 5 minutes before rinsing it off. Normally, seborrheic dermatitis is caused by an imbalance of the yeast called Malassezia furfur and normal flora (bacteria) on your scalp. Basically, there's too much yeast. The shampoo will help keeping control of the organisms while the Clobetasol shampoo and topical desoximethasone will help decrease the inflammation during in the beginning of the treatment.

[Eli_Avdikian]

6 minutes ago, Dr. Wipawan Vathananai said:

You can try these products;

- Ketoconazole shampoo

- Tar shampoo

- Selenium sulfide or Selenium disulfide shampoo

- Clobetasol shampoo (severe cases)

- Topical desoximethasone (moderate cases)

For the shampoo, please use it every 2 days in the beginning and make sure you leave it on your SCALP for at least 5 minutes before rinsing it off. Normally, seborrheic dermatitis is caused by an imbalance of the yeast called Malassezia furfur and normal flora (bacteria) on your scalp. Basically, there's too much yeast. The shampoo will help keeping control of the organisms while the Clobetasol shampoo and topical desoximethasone will help decrease the inflammation during in the beginning of the treatment.

Thank you !