Alopecia is associated with significant psychological burden. There is limited evidence on the use of psychological interventions in conditions of hair loss. This manuscript systematically reviews the current state of literature on psychological treatments for quality of life, mental health, and hair growth in various forms of alopecia. PubMed and Embase were searched with predefined inclusion and exclusion criteria. Reference lists were also examined for relevant studies. Nine articles met our criteria and are included in this review. Eight of the articles related to alopecia areata and one related to scarring alopecia. Mindfulness-based stress reduction (MBSR) was found to improve quality of life-related subjective symptoms, relationship impacts, anxiety, phobia, distress, and psychological symptom intensity. Alopecia-specific collocated behavioral health (CLBH) treatment showed a trend for psychosocial improvement in areas such as appearance shame, activity avoidance, negative emotions, and coping. Hypnotherapy was found to improve anxiety and depression, quality of life measures, and alexithymia. There was also some evidence for significant hair growth with hypnosis, but the data are mixed. Psychotherapy combined with immunotherapy led to more hair growth, and supported self-confidence. Finally, coping strategies modulated the subjective burden of alopecia, and were associated with disease improvement. Further research will be necessary to better establish the efficacy and optimal administration of these interventions in alopecia.

BACKGROUND: Lichen planopilaris (LPP) is a rare cicatricial alopecia characterized by perifollicular inflammation and progressive scarring hair loss. Case reports suggest a temporal association between facial and scalp surgical procedures and LPP development, though the literature remains fragmented. OBJECTIVE: To characterize published cases of LPP, including frontal fibrosing alopecia, occurring after hair transplantation or facial surgical procedures. METHODS: A systematic review was conducted using PubMed and Cochrane Library databases from inception through March 2023 following PRISMA guidelines. Given the study design heterogeneity, findings were synthesized qualitatively. Studies reporting new-onset LPP after scalp or facial procedures were included. RESULTS: Seven studies comprising 66 patients met inclusion criteria: 34 after hair transplantation and 32 after facial procedures. The mean age at diagnosis was 55.7 years, younger than the general LPP population. The mean latency from procedure to disease onset was 4.88 years. Lichen planopilaris developed at transplant sites in all cases with available localization data, with 44% demonstrating additional distant involvement. CONCLUSION: Surgical trauma to face and scalp may serve as a trigger for LPP in predisposed individuals, although a causal relationship remains unestablished, and subclinical LPP may have predated the procedure in some patients. Clinicians performing these procedures may consider discussing this rare complication.