Early removal of post-operative scabs after follicular unit extraction using a 2% salicylic acid keratolytic shampoo: a multicentre descriptive pilot study

Background Hair transplantation is increasingly performed for advanced androgenetic alopecia (AGA), yet postoperative scalp care remains poorly standardized. Persistent scabs after follicular unit extraction (FUE) may delay healing, compromise graft survival, and increase the risk of infection. Objective To evaluate the effectiveness and tolerability of a keratolytic shampoo containing 2% salicylic acid, piroctone olamine, and a micro-depositing conditioning polymer for the early management of postoperative scabs after FUE. Methods A prospective, multicenter, single-arm pilot study was conducted in 21 male patients following a structured 10-day washing protocol starting 48–72 h post-surgery. Investigator-assessed erythema, desquamation, and scab scores were recorded, along with patient-reported symptoms and satisfaction. Results Mean scab severity decreased from 2.67 ± 0.97 to 1.76 ± 0.62, indicating effective crust detachment without barrier disruption. Erythema increased transiently post-wash (1.90 ± 0.62 to 2.81 ± 1.21) but was not associated with burning, itching, or pain. The overall mean satisfaction score was 4.05 ± 0.77, with 76.2% of patients agreeing that the shampoo reduced scabs and 67% stating they would recommend it. No adverse events were recorded. Conclusion Continuous use of this 2% salicylic acid-based keratolytic cleanser from 48–72 h after FUE promoted gentle scab removal, excellent tolerability, and high patient satisfaction. Incorporating such formulations into early postoperative care may improve outcomes and comfort after hair transplantation.