A report describes a case of a 64-year-old female patient diagnosed with erosive pustular dermatosis of the scalp in frontal and temporal regions bilaterally. Her condition started after coronal rhytidoplasty 2 years before and evolved with extensive scarring alopecia. She received previous treatments with antibiotics and antifungals that were not successful.

Thus, the physicians initiated the treatment with prednisone 40 mg/day and topical tacrolimus, associated with a frequent change of dressings. One year of clinical therapy showed improvement and stability of the condition. The surgeons then planned a small reduction plastic surgery to observe possible disease relapse, which fortunately did not occur.

Two months later, they performed a 1-cm skin spindle scar resection in the healing transition of the hair under local anesthesia with 1: 200,000 lidocaine, bupivacaine and adrenaline solution and associated sedation. The surgeons made relaxation incisions in the aponeurotic galea in a checkered shape, placed a rectangular, smooth cutaneous expander and performed detachment with dissection scissors in a subgaleal plane of a scalp segment of about 10 cm anteroposteriorly and 20 cm laterally from the sagittal axis, symmetrically. They further performed suturing in separate planes with 2-0 polyglactin threads for galea, 4-0 poliglecaprone for sub-dermis and 4-0 mononylon for skin, vertical mattress type. After dressing, they filled the expander with 50 mL of physiological saline solution.

They performed weekly expansions with physiological saline until it reached a final volume of 300 mL. After 21 days, they interrupted the expansions by local pain and the development of an alopecia areata-like area due to pressure in the subcutaneous region. They removed the expander after 3 months and advanced the scalp flap (about 4 cm), restoring the anterior hairline properly.

The surgeons noted a good postoperative evolution. Her pressure alopecia was reversed spontaneously 6 months after the removal of the expander, and the patient showed satisfaction with the final result.

Source: Ferreira RA, Contin LA, Rocha VB, et al. Reconstruction of scalp anterior hairline with tissue expansion and skin flap. Skin Appendage Disord. 2022;8(3):261-4.