Dear Editor,
A 40-year-old male with no comorbidities underwent lumbar decompression and fusion surgery. It was an uneventful surgery that lasted 180 minutes in the prone position. He did not have any pressure marks on his face or body. The patient was discharged from the hospital, in his follow-up after 2 weeks, he presented with a patch of alopecia on his chin. He has no itching, redness, or swelling in the same area. On examination, there is a patch of alopecia on the chin. There was no obvious scar in the area, no tenderness, and the surrounding area had normal beard growth (Figure 1 A).
Figure 1
A): Shows a patch of alopecia on chin after 2 weeks following surgery; B): Shows regrowth of beard hair in same area after 8 weeks following surgery
His sensations remained the same in the area as the rest of the face. A dermatology review was taken to rule out any other cause of alopecia. There was no other etiology that could explain the presentation. This was probably a sequela of pressure effects in the local site during the prone position. Pressure alopecia is well-reported in the literature on scalp hair and its risk factors.1, 2 Here we present a case with pressure alopecia of beard in the prone position. We routinely use a soft face cushion in the prone position, where we encounter redness over the forehead, cheeks, and chin in a small group of patients. This usually resolves spontaneously over a few days. Also, this patient had no facial redness or skin peeling after the surgery. This has been referred to as a compromise in blood flow to hair follicles due to pressure effects on capillaries in the prone position. After a dermatology consultation, it was labeled as pressure alopecia. The patient was counseled about the complication and possible cause. A follow-up at 8 weeks following surgery revealed regrowth in the same areas. It was important to address the psychological aspect of the patient. This cosmetic complication affects confidence in daily life. Here we report a rare complication of beard alopecia due to pressure effects during a prone position. Also, a follow-up image showing the reversible nature of the complication.
