title: Postoperative alopecia areata: is pressure-induced ischemia the only cause to blame?
abstract: BACKGROUND
  Postoperative alopecia areata (PAA) following surgery has been reported, especially after certain gynecologic and cardiac procedures; however, no cases have been reported after liver transplant (LT). Localized pressure associated with prolonged anesthesia is usually blamed. Herein we report a few cases of PAA encountered especially in relation to LT procedures.
  
  
  OBJECTIVE
  To report our PAA cases, identifying possible contributing risk factors.
  
  
  METHODS
  Between April 2001 and May 2003 the data on eight PAA cases were analyzed for age, sex, type of surgery, duration of anesthesia, type of head support, periods of hypotension, and psychiatric comorbidity.
  
  
  RESULTS
  Median age of affected patients was 27 years (10 to 44) and the male/female ratio 3/5. The type of surgery included: two LT recipients, two LT donors, three cardiac valve replacements, and one coronary bypass surgery. Median anesthesia time was 6 hours (3 to 12). Sponge or jelly donut was used for head support with frequent change of its position as per protocol. There were no significant periods of hypotension. Surprisingly, almost all patients had a documented psychiatric comorbidity, mainly anxiety, adjustment/adaptation, or mood disorders.
  
  
  CONCLUSIONS
  PAA is a rare complication following certain surgeries including both donor and recipient LT procedures. Although pressure-induced ischemia is the most likely etiological factor, we believe that psychiatric comorbidity plays a major role in its development. Therefore, preoperative thorough psychiatric counseling in addition to frequent intraoperative head repositioning will help to avoid this minor but distressing postoperative complication.
authors.affiliation: Department of Liver Transplantation and Hepatobiliary-Pancreatic Surgery, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia. haterm_khalaf@hotmail.com
authors.forename: H
authors.initials: H
authors.lastname: Khalaf
authors.forename: H
authors.initials: H
authors.lastname: Negmi
authors.forename: G
authors.initials: G
authors.lastname: Hassan
authors.forename: M
authors.initials: M
authors.lastname: Al-Sebayel
mesh_terms: D000293:Adolescent; D000328:Adult; D000506:Alopecia Areata / Q000453:epidemiology*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D002648:Child; D005260:Female; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology*