Do steroid injections help or hinder donor scar healing?

[Dan26]

Thanks, 35YrsAfter, for your question. That's the fundamental question that this study set out to investigate: steroids' benefit of swelling reduction versus their potential inhibition of wound healing.

Rather than simply dismissing a valid question as worthless. Our office has taken the time to investigate the true effect of local corticosteroid injections on donor wound edge apposition. As Dr. Cole mentioned, there are certainly potential risks to corticosteroid injections in the donor area (wound dehiscence, etc.). These were not observed in our study that focused on early-phase wound edge apposition. It's also true that a more long-term investigation will yield more information regarding this question. I, along with its co-authors Drs. Walter and Robin Unger, plan to perform this subsequent study to shed light on this topic.

What about a combination of a corticosteroid with something such as calcipitriol? Which reduces some of the skin atrophy/thinning effects of the steroid. And it is great for reduction of inflammation and perhaps even elevated dermal factors ie. pdg2

[Dan26]

I always wondered if steroid injections could stimulate hair regrowth WITHOUT a hair transplant. I know that they can work in patients with alopecia areata by suppressing the immune system from attacking the hair follicle, but I always wondered if they could be used as a stand-alone treatment to stimulate the dormant hair follicles in people suffering from androgenetic alopecia.

I believe there on some regrowth properties of certain steroid-based compounds in conjunction with other ant-inflammatory compounds. Either way, fighting inflammation is a key component of hair loss. I read a study that compared betamethasone, tacrolimus, and calcipitriol, as well as all those three compounds paired with one another. There were certainly some positive benefits.

[J_B_Davis]

It's good to see some real studies being conducted on this stuff Dr. Wesley. Thank you for sharing this. I have to question why doctor Cole and his staff work so hard on the forums to discredit other techniques? It's a little low brow if you ask me.

[John P. Cole, MD]

If you are looking at the 8 day mark, then your efforts really are worthless because strips look about the same right up to the about the 3rd month. If you were looking at the 8 day mark only to show that the strip wound did not go all to hell, then I guess you showed it. If you take it to 3 months, i doubt you will see any difference, but you really should do this especially given that you've already taken the time to do this much work. Hey, you are doing a study. That's more than most people do. I'd love to eat crow on this one and have you find that the procedure produces a benefit, but I'm certain that I will not.

i think my concern is that studies suggesting benefits from strip surgery might induce an individual into a strip with steroid injections due to a false sense of hope that his scar will be less visible. i think it is much better to do the study and then report the results because it seems like a you are anticipating a benefit before you get one.

Follow up your patients and report your results. It will be interesting even if you report scar width by month. Other than Beehner, Perez, and my studies, i'm not aware of any other studies looking at strip width by month. That alone will be of interest.

Actually, inflammation is probably a good thing especially in the recipient area. We should probably be looking to eliminate steroids rather than use more of them. PRP induces inflammation especially when the granulocyte count is high. I don't think you necessarily need a high granulocyte count to induce hair growth from PRP, but this would be a far more interesting study and one that you should consider. Look at a variable platelet concentration and a variable graunulocyte concentration with and without steroids for evidence of improved hair diameter, pigmentation, and rate of growth in the recipient area. That' s a steroid study that has legs.

[John P. Cole, MD]

By the way, I like physicians who do studies and evaluate patient results. These are the guys who are paying attention to their results. It is those who pay attention to their results that recognize their mistakes. The first step in correcting one's mistakes is recognizing them. I've made plenty of mistakes over the years and always done my best to correct them. Of course, one of my greatest mistakes was listening to my peers and mentors about what was in the best interest of my patient. I soon learned to stop listening to them and start listening to my eyes. That's why i don't mind going toe to toe with anyone who promotes strip procedures as a predominate practice.

[Carlos Wesley, MD]

As one of our field's important innovators, Dr. Cole is certainly not trying to stamp out important studies. However, the answer to this question may not necessarily be so black and white. Even with respect to this investigation on early-phase wound healing, trends could be detected when isolating each variable (closing tension, etc.). Using a combination of a fairly detailed measurement system (I've attached the image of our approach) and strong statistical analysis, we're hoping to pick up any difference (positive or negative) that this variable (corticosteroid injection on wound healing) may have.

Regarding PRP: I'm also glad that was mentioned because our office is also in the midst of investigating their effect on the recipient area. On Friday, we marched over 20+ PRP samples to Mt. Sinai Medical Center for an analysis of both their cellular and growth factor profiles. We're trying to couple the question, "What is PRP?" with the question, "How does it effect hair growth?". Based on our findings, we're planning to expand this analysis over the next few months.

Finally, as my patients are well aware, I'm certainly not one to promote the status quo in our field. Whether it be strip harvest, FUE, or something superior to both, we should be looking out for the harvesting method that has the least impact on the donor with the greatest benefit to the recipient area.

[John P. Cole, MD]

Excellent. I look forward to your results and cell studies.