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The patient noticed a small, round patch of hair loss in his beard 9\u2009months after the second AR episode, which occurred 21\u00a0months post\u2010transplantation. Biopsy of the alopecic patch showed lichen\u2010planopilaris\u2010like features, which were suggestive of early CR. Despite an increase in immunosuppressive dosages, the alopecia progressed. Following the second and third AR\/CR episodes, the alopecia became more pronounced, with the addition of hyperpigmentation as well as sclerosis and telangiectasia. The findings of multiple biopsies showed CR. Based on these findings we think that alopecia with lichen\u2010planopilaris\u2010like histopathological features similar to grade III AR features, particularly in hair follicles appears to be an early finding of CR in the presented patient. The findings further indicate that follicular involvement may be a significant feature of CR in VCA patients and that it can present prior to sclerosis, vasculopathy, or loss of adnexa. The present case is uniquely important because of the distinctive presentation of CR, with hair follicles clinically and histopathologically affected, leading to progressive and irreversible alopecia with lichen\u2010planopilaris\u2010like histopathology.<\/jats:p>","DOI":"10.1111\/cup.14069","type":"journal-article","created":{"date-parts":[[2021,6,4]],"date-time":"2021-06-04T02:43:54Z","timestamp":1622774634000},"page":"1286-1297","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Early recognition of chronic rejection in a face allotransplant patient with alopecia"],"prefix":"10.1111","volume":"48","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1137-5399","authenticated-orcid":false,"given":"Neslihan","family":"Akdogan","sequence":"first","affiliation":[{"name":"Department of Dermatology, School of Medicine Hacettepe University  Ankara Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5040-2476","authenticated-orcid":false,"given":"Sibel","family":"Ersoy\u2010Evans","sequence":"additional","affiliation":[{"name":"Department of Dermatology, School of Medicine Hacettepe University  Ankara Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9537-1127","authenticated-orcid":false,"given":"Ozay","family":"Gokoz","sequence":"additional","affiliation":[{"name":"Department of Pathology, School of Medicine Hacettepe University  Ankara Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5389-3143","authenticated-orcid":false,"given":"Yunus","family":"Erdem","sequence":"additional","affiliation":[{"name":"Department of Nephrology, School of Medicine Hacettepe University  Ankara Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5168-288X","authenticated-orcid":false,"given":"Serdar","family":"Nasir","sequence":"additional","affiliation":[{"name":"Department of Plastic, Reconstructive and Aesthetic Surgery, School of Medicine Hacettepe University  Ankara Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,6,16]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cps.2017.05.017"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0000000000002149"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/SCS.0000000000002800"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1101\/cshperspect.a015461"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-6143.2008.02243.x"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/ajt.12590"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1097\/TP.0000000000000765"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/ajt.14218"},{"key":"e_1_2_6_10_1","unstructured":"CNN. 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