Oral isotretinoin in hair transplant patients and its effect on wound healing

Androgenetic alopecia is a genetically predetermined disorder due to excessive response to androgens, impacting approximately 50% of males and females.[1,2,3,]FDA approved treatments include minoxidil, finasteride and LLLT[4]

For many, medical treatment alone does not provide desired results and surgical treatment of AGA has gained popularity over the past several decades. Today the most widely used technique is micrografting by the follicular unit extraction method. This outpatient procedure requires a great deal of technical skill and endurance on the part of the surgeon. [5,6]

Hair transplantation is a relatively safe surgery and is associated with very few complications. It is a cosmetic surgery so the complications may impact social and psychological aspect of the patient. Folliculitis after hair transplant surgery is a common complication with potentially multiple etiologies. Chronic lesions of superficial folliculitis may develop into deep folliculitis, and conversely, severe postoperative folliculitis may lead to cellulitis or furunculosis, which can result in scarring and hair loss.[7]

Isotretinoin (13-cis-retinoic acid) is a retinoid derivative of vitamin A approved by the FDA of the United States and Europe (excluding Sweden) in 1982 and 1983, respectively. Its primary use is for treating severe recalcitrant cases of acne vulgaris.[8] It works by reducing the size of sebaceous glands, lowering sebum excretion, regulating cell proliferation, and decreasing keratinization. Isotretinoin can alter the microenvironment of the follicles, resulting in a decrease in the number of Cutibacterium acnes. [9,10] Additionally, it possesses anti-inflammatory and immunomodulatory properties by reducing monocyte TLR-2 expression, minimizing the inflammatory cytokine response, and antineoplastic properties, making it a valuable treatment option for various skin diseases. [11,12]

Isotretinoin due to its multiple action of  inhibition of the lipid production of the sebaceous glands, while having a direct inhibitory effect on the immune system. It reduces the expression of different matrix-metalloproteinases and therefore inhibits the migration of neutrophils into the skin. [13] Furthermore, it leads to a decrease in expression of toll-like receptor 2, which mediates the immune response to Gram-positive bacteria. [14]

Research is needed to determine the effectiveness of oral isotretinoin for hair transplant patients, preventing post hair transplant complications and have a beneficial effect on wound healing post procedure. There is a paucity of data about the effectiveness of oral isotretinoin as a preventive measure to reduce complications in hair transplant cases which prompted us to do this study.