Description, Causes and Risk Factors:
Loss of hair over a circumscribed area usually on the posterior scalp, resulting from the continuous pressure on the occiput in lengthy operative procedures.
Pressure alopecia is probably underreported. It occurs following hypotensive or complicated surgery and prolonged stays in ICU, when patients require intubation. The constant pressure on the scalp is causative and may be exacerbated by hypoxemia or hypotension. There may be some correlation between the length of time spent under anesthesia and the development of permanent alopecia. Reports confirm that regular head turning schedules eliminate the problem, and this should be advocated as prophylaxis to avoid permanent alopecia. A prospective multi-center study in high-risk cohorts may shed further light on this enigmatic condition.
The phenomenon of pressure alopecia is not exclusive limited to adults. It has also been described in children and neonates postoperatively and following stays in ICU.
Occipital pressure ulcers leading to alopecia have been documented in injured soldiers. In a retrospective prevalence study, physicians noted pressure ulcers in Military personnel admitted to a polytrauma rehabilitation center in NA and Iraq.
Pressure alopecia may also occurs in many surgical procedures including ophthalmology, GYN (gynecology), breast surgeries, oromaxillofacial surgery, cardiac surgeries, and burn injuries.
Pressure alopecia typically presents with a discrete area of alopecia, usually in the occiput, within a few weeks of surgery or a prolonged period in an ICU. Some patients experience tenderness, swelling, or ulceration in the scalp prior to the alopecia, but in others, the alopecia may be the presenting feature.
There is no definitive histopathological appearance for pressure alopecia; various findings have been described in the literature. Fibrosis with loss of hair follicles has been noted in those with scarring alopecia. Other findings that have been reported include chronic inflammation and foreign body granulomatous reactions.
Treatment aims to slow or reduce hair loss, stimulate partial re-growth or replace damaged hair. Non-surgical treatments include lotions and tablets. These generally need to be used continuously to maintain re-growth. If treatment is stopped, re-growth ceases and hair loss will start again. Cosmetic options include wigs and hairpieces.
A number of other treatments have been suggested for hair loss including massage, vitamin supplements, herbal remedies (such as saw palmetto), zinc, amino acids, hair lotions and tonics. None of these has been shown to promote hair growth or prevent hair loss.
Surgical treatment involving hair transplantation is available from hair transplant surgeons and can be helpful for some men with advanced balding.
There is also no scientific evidence that the use of lasers is effective.
NOTE: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.
DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.
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