mcr7777

Yes it was a biopsy.  Dermatologists seem unsure on the diagnosis though - I definitely have folliculitis, see term and MPB - and no further hair loss for 4+ years.

It's hard to tell what I'm looking at in this photo...but looks like you might have scale around the hair?  

The white bulb attached to the end of hair isn't the bulb or root- it's a keratin sac.  The bulb or root doesn't fall out with LPP - or any hair condition that I'm aware of.

Did you have a biopsy that indicated LPP?

On 12/14/2023 at 8:28 AM, xabi86 said:

Hey @mcr7777

I am also from the UK. How do you order from Farmacia Patari please? I couldn’t find a website as such.

Also, I believe you need a prescription, where can I get one from please? My GP won’t 🙂

thanks

Hey, sorry for the delay - I've checked my email and it's actually Farmaci Tristiana that I order from in Andorra. They have loads of options - and can compound additional things if you request it.  Just make sure you're ordering the right strengths as there are lots of options.

I usually use normal shipping.  If I'm not home, the Royal Mail holds it - and doesn't always issue a note - so I have to collect it at the local sorting office.  Royal Mail have been able to track the shipping number issued by the Spanish Postal service which the pharmacy uses.

On 11/22/2023 at 11:07 PM, ScottishGuy21 said:

7 weeks on from the original issue and I’ve bounced back fairly well. Thickness and density have improved no end (Thankfully 🙏🏼)
 

Things are still ongoing with a hair specific dermatologist to try and pin point the exact cause but my hair is in a much better place now 

 

 

 

 

 

 

 

I've been actively fighting scalp

inflammation for a few years now  - you can DM me if you have  questions.

You should

On 11/27/2023 at 12:44 PM, pnl said:

Dear members.

I am a 29-year-old man who started taking Dutasteride five years ago. Over the past 5 years, I have been able to maintain my hair. However, this summer, I suddenly and rapidly (within 2 months) started losing hair and became bald. In a very short period, I lost a lot of hair. It is now November, and I can see that it is slowly starting to grow back. However, it is still far from how it was before the summer. Now I have 2 questions.

Can Dutasteride suddenly stop working after 5 years?
If it no longer works, why are the hairs growing back slowly (or is this part of the miniaturization process)?

Thank you!

 

You should find a specialist hair dermatologist -you might have an inflammatory or autoimmune condition e.g. LPP or Areata - or something else.  It doesn't appear to be usual MBP based on the pattern and speed.

On 9/30/2023 at 7:14 PM, WreckedOne said:

• 36y old. Was NW6 previously. 
• Had two surgeries with dr. Sanusi Umar over the last 3 years. Despite not many reviews from his patients on HT forums, I thought I did a good research at the time.I saw pictures of one of his old patients that had same level of loss and later appeared to have full head of hair. Haven’t seen it from anybody else at the time. Also saw he was promoting himself as fixing bad transplants from other surgeons. Had money, and decided to travel from Europe to California to see him. Payed him over $50k for transplant (+ flights, accommdation, his medicine, etc). Overall spent over $70k on this. Wanted to do it right, avoid Turkey with mass transplants, etc. But what a mistake it turend out to be…
   
• In first procedure he aggressively transplanted 7600 grafts over 4 days (hair 2900, neck 590, beard: 4000, thigh: 140). Scalp redness for longer time (5/6+ months). After a year, I think maybe 15% successful grafts (and almost all beard hair fell out). He made hairline way too agressive reasoning that I will be transplanting lot of grafts. My forehead wrinkles touching the hairline. He put the strong hairs on the sides, which looks unnatural. Also hairline grafts appeared to stick much more then the rest, so it’s like having someone draw a circle on my scalp, and then being empty inside.
   
• He didn’t really understand why the growth is not good, and then he told me that it appears that some of his patients had condition called LPP (lichen planopilaris), and he wanted me to test for it. But he didn’t say I can test in Europe (he said he doesn’t trust doctors here), so year after first procedure I went again to see him, he did biopsy and it came with confirmed LPP. Then he asked me if I want to do 2nd procedure. And obviously travling half the world to see him expecting to have the 2nd procedure, I didn’t want to go back home just doing biopsy that I could have done in Europe as well. Terrible from him. Other doctors later told me, that he should have never asked me nor do the 2nd procedure, until LPP is calmed down. I don’t know at what state the LPP was at that moment, but like I said it was confirmed.
  So, did 3200 grafts over 3 days (only head hair) + fat injections. He didn’t charge for this procedure, as it was basically repair of the failed first one. Growth was better with this procedure (hard to say % wise how successful) but density remained big issue. 
   

• Before 2nd procedure, me asking about grafts I have left, he told me I don’t have to worry and that I have many grafts which he can use. But I did worry rightly from where he will take additional grafts. After I asked him again about this he mentioned that he needs to take grafts from the beard (what’s left) and that I can think of doing light micropigmentation. After that I completely lost trust in dr. Umar, and stopped communicating with him. At that point he transplanted almost 11,000 grafts, with very low success rate and he wanted to do another from beard, knowing that almost all previous beard grafts fell off. It was just crazy.
   
• Also, before the procedures, he told me I will not need to take medicines like Finasteride, etc. Later on he put me on Minoxidil, Finasteride, and then switch Finasteride with Dutasteride. It affected me also mentally and physically (loss of sex drive, etc). After taking them as per instructions for over 1.5 years, I stopped after I lost trust with Umar.
   
• After doing new research, I consulted with top doctors (Pekiner, Mwamba, Bisanga, Zarev, etc). Unfortunately they confirmed my doubts. Almost all refused to do operation on me. Bisanga said Umar was too agressive with first op, and that they would never do that. Zarev refused and said good density couldn’t be achieved due to not enough grafts in donor area. Pekiner and Mwamba were willing to have live consultation at least, but I decided to consult and see well rated HT surgeon that was nearer first.
   
• Went for a live consultation with one surgeon where he confirmed that I have maybe 1000 grafts left. Without knowing at which doctor I went previously, he pointed many mistakes Umar made and said he was way too agressive, that he should have seen LPP immediately if there was one, and suspecting that he didn’t see it because there was no LPP before him, and that his aggressive approach with 7600 grafts over 4 days could have resulted in LPP in the first place, also that my hairline was done too low, unnatural, etc. And I agree with everything he said, as I was suspecting all of this. After he gave his opinion, only then I told him my 2 procedures were with Dr. Sanusi Umar, and he was shocked just looking at me for a few moments without saying word. He never saw his patients, but he knew him, and thought that he is top surgeon. He told me honestly that he thought at beginning that I went to cheap Turkish clinics, one of those surgeons that agriculture in the morning and surgery in the afternoon.
   
• I don’t even want to mention his pricey hair oil and vitamins he asks you to take. That oil you should put 2 per day and wear for hours, your scalp changes color, and you can’t go anywhere with that on your head… It’s ridicolous, and there was no difference once I stopped truting Umar and stopped taking also that oil some 10 months after second surgery.
   
• Summary: I thought I was going to the top hair transplant surgeon, traveling half the world to do the procedures, with overall cost going over $70k, and he wrecked me completely. It’s even worse than if I was bold. When I was bold I was just another bold dude, but now due to low density and stronger hair with more density on the harline it’s very visible and people notice immediately. It costed me and still does a lot of mental health, (avoidance of social gatherings, being self-conscious about this and constantly getting feedback from others in terms of eye looks at the hair, etc). I’ve let it grew longer few times only to see that density difference is just too grave and it looks much worse. I’m constantly trimming my hair with 0 clipper. But even when clipped to 0, it doesn’t look natural due to density difference. It went from having big expectations prior to the surgeries (as I thought I’m going to the top doctor and paying top money for great result), to going much below the baseline bold feeling, going through a lot of emotional pain due to all that.
   
• Did micropigmentation after that, but it didn’t help much really. It does look a bit better when clipped to 0, so I can at least be comfortable enough to go out without hat (I can’t stand the hats anymore at this point).
   
• Scheduled another procedure (with the surgeon I saw live) for February next year (he checked and no signs of LPP are visible now) to transplant remaining 1000 grafts to improve if possible at least a little bit. The plan is to laser off his hairline, and move my hairline less agressively so that it can look more natural. I don’t really have hope I will be able to grow hair looking normally, as it will still likely be too little density to be able to cover it normally. But at least then I will know I did everything I could, and if I can’t achieve normal look, will just keep clipping or shaving it until the rest of my life.
   
• Had to write down this and get it out! Be careful and do your research well! Avoid aggressive surgeons that are doing lot of grafts over short time and don’t have many patient reveiws on forums like this, no matter how good they appear or promote themselves!

 

Before the procedures:

11 months after 1st procedure with 7600 grafts:

3 months after 2nd procedure with fat injections and 3200 head grafts (total cca 11k grafts now) :

7 months after 2nd procedure:

13 months after 2nd HT and after micropigmentation  (TODAY in daylight):

 

I'm very sorry about this.. I was diagnosed with LPP after my HT (I think I had it before HT). LPP largely under control now.

 Dr. should never have offered to do a 2nd procedure until LPP was calmed/treated.   

Did you have LPP symptoms before HT - and now?

I've used anagencia and now direct from Parati - no issues with either and get my shipment fairly quickly to the UK (within a week or two) via the Spanish post - they will provide tracking number if you ask.

I use 0.1% topical but - average 1ml 2-3 times per week or so (sometimes I use 5-6 days/week but smaller dosage per day).  I've been using for around 9 months now - less minaturised hair for sure.

I used oral fin 1x day for 1.5 years and had mild/moderate sides - nothing similar on topical DUT thankfully.

22 hours ago, jjalay said:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8061642/

I dont necessarily agrre with this conclusion. I think it has more to do with the longevity of the hair follicles of the donor area.

What are your thoughts on this matter?

This is a very interesting study - I wonder if inflammation could be one of the causes. It's known that many with AGA have co-current inflammation to varying degrees and treating the inflammation is not well understood.  I was diagnosed with LPP 1 year after HT....not sure it that is what I have or something else. 

On 6/1/2023 at 12:34 PM, consequence said:

Terrifying infection. What's the worst about LPP is that in its milder form it just looks like AGA. A significant percentage of people who think they're just suffering from typical male pattern balding actually have a chronic fungus.

Think about that next time you're at the gym and about to lay your head on that sweaty bench press.

Agree LPP is not nice - but it's not contagious.  It's an autoimmune condition - it's not a fungus/bacterial/viral and not something you can catch from others or at the gym.

I'd suggest seeing a specialist hair dermatologist - if there is inflammation, something like a topical steroid might help (I have an inflmmatory hair condition and the topical steroids help me).  Diagnosing these conditions can be a challenge - hence it's best to find an expert hair doctor rather than a generalist.

On 4/3/2023 at 9:22 PM, mcr7777 said:

So...as far as I'm aware LP is pretty rare in people with LPP and vice versa.  LP also tends not to chronic (unlike LPP unfortunately).  I'm a member of the FB group for LPP and very few people have LP too - although of course some do on a group of 2000 people.  I believe the risk is elevated but it's still pretty rare to have both conditions.  I think I read itch is present in 70+% of LPP cases.....eyebrow thinning tends to be more with LPP but also FAPD and occasionally LPP too.

Sorry I meant to say eyebrow thinning tends to be more common with FFA.

Interestingly I've read that DUT half life for oral is 5 week....but half life is dose dependent.  I've seen it suggested that topical dut doses may be in the days rather than weeks...see post and study below.

On 3/30/2023 at 6:26 AM, Jayson1361 said:

This is an interesting thread. I actually have oral lichen planus and had concerns about it moving to my scalp somehow. I’ve not been too concerned about it as I’ve responded to Avodart over the years and had some response to oral minoxidil. Also, I have no eyebrow thinning or white patches on the forehead that I can see. I’ve also not had all day scalp itching but have had scalp itch here and there which I always attributed to the DHT itch, drying from dandruff shampoos or product build up…etc. I don’t have any patchy balding or thinning, or symmetrical recession from the forelock back… but rather temporal thinning with what I perceive some diffuse miniaturization in the front. A few times after styling with gel and pressing down on the crown I felt a slight burning sensation which sparked my interest into this topic. I have not pursued a biopsy but after seeing this I’m going to as the bulk of my thinning is focused in the front with more aggressive miniaturization over the last two years. However, it seems that FFA from LPP doesn’t really do the whole slow miniaturization process like MPB therefore I’m still in question if this is occurring for me. But, seeing this here has sparked my concern. Thanks for the post. 

So...as far as I'm aware LP is pretty rare in people with LPP and vice versa.  LP also tends not to chronic (unlike LPP unfortunately).  I'm a member of the FB group for LPP and very few people have LP too - although of course some do on a group of 2000 people.  I believe the risk is elevated but it's still pretty rare to have both conditions.  I think I read itch is present in 70+% of LPP cases.....eyebrow thinning tends to be more with LPP but also FAPD and occasionally LPP too.

On 3/30/2023 at 6:26 AM, Jayson1361 said:

This is an interesting thread. I actually have oral lichen planus and had concerns about it moving to my scalp somehow. I’ve not been too concerned about it as I’ve responded to Avodart over the years and had some response to oral minoxidil. Also, I have no eyebrow thinning or white patches on the forehead that I can see. I’ve also not had all day scalp itching but have had scalp itch here and there which I always attributed to the DHT itch, drying from dandruff shampoos or product build up…etc. I don’t have any patchy balding or thinning, or symmetrical recession from the forelock back… but rather temporal thinning with what I perceive some diffuse miniaturization in the front. A few times after styling with gel and pressing down on the crown I felt a slight burning sensation which sparked my interest into this topic. I have not pursued a biopsy but after seeing this I’m going to as the bulk of my thinning is focused in the front with more aggressive miniaturization over the last two years. However, it seems that FFA from LPP doesn’t really do the whole slow miniaturization process like MPB therefore I’m still in question if this is occurring for me. But, seeing this here has sparked my concern. Thanks for the post. 

So...as far as I'm aware LP is pretty rare in people with LPP and vice versa.  LP also tends not to chronic (unlike LPP unfortunately).  I'm a member of the FB group for LPP and very few people have LP too - although of course some do on a group of 2000 people.  I believe the risk is elevated but it's still pretty rare to have both conditions.  I think I read itch is present in 70+% of LPP cases.....eyebrow thinning tends to be more with LPP but also FAPD and occasionally LPP too.

On 3/30/2023 at 6:26 AM, Jayson1361 said:

This is an interesting thread. I actually have oral lichen planus and had concerns about it moving to my scalp somehow. I’ve not been too concerned about it as I’ve responded to Avodart over the years and had some response to oral minoxidil. Also, I have no eyebrow thinning or white patches on the forehead that I can see. I’ve also not had all day scalp itching but have had scalp itch here and there which I always attributed to the DHT itch, drying from dandruff shampoos or product build up…etc. I don’t have any patchy balding or thinning, or symmetrical recession from the forelock back… but rather temporal thinning with what I perceive some diffuse miniaturization in the front. A few times after styling with gel and pressing down on the crown I felt a slight burning sensation which sparked my interest into this topic. I have not pursued a biopsy but after seeing this I’m going to as the bulk of my thinning is focused in the front with more aggressive miniaturization over the last two years. However, it seems that FFA from LPP doesn’t really do the whole slow miniaturization process like MPB therefore I’m still in question if this is occurring for me. But, seeing this here has sparked my concern. Thanks for the post. 

So...as far as I'm aware LP is pretty rare in people with LPP and vice versa.  LP also tends not to chronic (unlike LPP unfortunately).  I'm a member of the FB group for LPP and very few people have LP too - although of course some do on a group of 2000 people.  I believe the risk is elevated but it's still pretty rare to have both conditions.  I think I read itch is present in 70+% of LPP cases.....eyebrow thinning tends to be more with LPP but also FAPD and occasionally LPP too.

On 4/2/2023 at 8:30 AM, MattJosh said:

Doesn't almost everyone has some inflammation to one degree or another? Even just basic dandruff or those with seborrheic dermatitis who have successful transplants and there are plenty would be considered to have inflammation

How would you define inflammation in the scalp?

This is why many docs recommend biopsies unless the diagnosis is obvious by dermoscope/digital microsocope.

Biopsies of LPP show specific types of dense inflmmation e.g. reduction of sebaceous glands, perifollicular lymphotic infiltriate (this is the immune cell attacking hairs)...Some cases of AGA also have lymphotic inflammation - I beleive this can account for poor HT results in some cases.

You can read more about it here:

https://donovanmedical.com/hair-blog/lpp-biopsy

https://donovanmedical.com/qow-posts/ffa-bx

10 minutes ago, NikosHair said:

That sounds promising.

Have you seen improvements?

It's only 2 months in and too soon to say - but I'm shedding less miniaturised hair (I have LPP with minaturisation - not sure if it will help for my LPP).  Hair derms I've seen for past years say they only prescribe topicals now - so pretty confident it will help  based on anecdotal feedback and studies. 

On 3/21/2023 at 11:03 PM, NikosHair said:

This is a very topical question (see what I did there🙄)

I've been looking at the extortionate prices for topical finasteride/dutasteride. By my calculations, you are looking at between $300 - $360 for a 3-month supply Vs $25 (delivered) generic oral finasteride.

With reference to the study @Melvin- Moderator kindly cited. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9297965/

The study does nothing to support the case for using topical finasteride, other than it was better than using nothing (placebo).

It would be interesting to hear your views and the study is a good starting point to support your views, either way.

 

I believe paid around 100 Euros for a 3 month supply of topical dut from Fue Clinic including delivery to the UK.  No issues with delivery. Still more than oral but less than quoted above.  Side effects from oral dut (minimal) are WAY less than I had on FIN after 2 months of using between 1 and 2 ml per week.

Which makes things more confusing is that MBP also causes fibrosis in late stages - and some biopsies of MPB show inflammation. I'm still not sure what the difference is between MBP with inflammation and FAPD  (a type of LPP that is like a mix of MBP and LPP), it may be there is no difference but it's so hard to get a diagnosis of LPP...it probably goes way underdiagnosed as most people don't want to go through a biopsy.  And biopsies are not 100% defintiive in any case.  See below about AGA with inflammation. I do wonder if this is what accounts for many of the poor HT results

https://donovanmedical.com/hair-blog/aga-inflammation

Just having a bit of itching is probably no cause for alarm but if you have it badly especailly along with other symptoms... you might want to look into it.

7 hours ago, Henry said:

I'm pretty sure have lpp as well, i have significant sideburn thinning, I've had chronically itchy scalp since i can remember and... I just had a 2700 graft hair transplant, I'm pretty much screwed now. I am taking doxycycline though which I've read just now, helps with lpp, (I'm taking it for pimples for the scalp.). Basically i just have trash genetics when it comes to hair. 

I'm from the Philippines which I'm not even sure doctors know what a biopsy means here so, there's no hope in officially diagnosing this thing. 

Can you share what you're regiment is that could probably potentially help me or others that might suspect have this condition?

My  HT has actually held up better than expected - it's been 3 years since I had it (1100 grafts).  I've tried different LPP treatments and currently taking topical steroids, topical tacrolimus (compouned) and 10mg of cetirizine daily.  Also added in topical dut 1x daily from fue clininc 2 months ago - too soon to say if the latter is working but seems like less sheddding so far. 

IF you have pimples on the scalp it could be folliculties or scalp acne (can also come with LPP sometimes). I get the same and salycylic acid scalp wash seems to help (you can find them on amazon). Also salyclic acid shampoo like neutrogena t-gel for itchy scalp might help.  Good lucky and try not to worry too much - hopefully will be better than before the transplatn.

On 3/27/2023 at 5:44 PM, MattJosh said:

Interesting, where did you get this from? From what I read in various sources, it seems that one of the main elements of scarring alopecias is that in the vast majority of cases once the hair falls it never grows back

I may have misunderstood the question.... if the area is scarred ie there are no stem cells left, the hair won't grow back. 

This can be a long or short process to happen.  And sometimes goes through more than 1 hair cycle to scar from LPP

ie not every hair shed won't grow back if you have LPP....but it's a progressive condition that tends to spread, especially if left untreated.

On 3/23/2023 at 10:37 PM, mcr7777 said:

They can grow keep growing back for a while but usually eventually they won't grow back if left untrated....it depends how much activity there is....LPP can be slow moving or more agressive.

 

 

On 3/23/2023 at 10:37 PM, mcr7777 said:

They can grow keep growing back  but with different texture and not as long as before....it depends how much activity there is....LPP can be slow moving or more agressive.

 

They can grow keep growing back  but with different texture and not as long as before....it depends how much activity there is....LPP can be slow moving or more agressive.

LPP is poorly understood -and I'm guessing way underdiagnosed in males.   Not everyone gets thinning/eyebrows or side burns - but the majority do have itching. 

There  is an overlap LPP/MBP condition called FAPD (Fibrosing alopecia in a pattern distribution). 

With LPP and hair transplants there are no certainties - for some they take but eventually fall out a few years later for examples.  For others they get very poor growth - or some combination of the above. I believe some may do well over time but I struggle to find lots of examples as case studies seem to stop after a few years.

There is no 'cure' for autoimmune - this or others - but there are many treatments. It's a difficult condition to treat but many people get in under control after treatment starts. My symptoms have gotten away better but it still flares from time to time.

Check out Dr. Donovan's hair pages on LPP  - loads of information on it.

On 2/13/2023 at 12:52 PM, Ronnieman said:

A weird question guys, but relevant for me:

 

Could topical dut go systematic through a cut in the finger? I slightly cut my finger yesterday while opening the FUEclinic topical dut bottle. I used the other hand for the dropper and massaging the Dut in, but when I washed my hands, my finger touched the other hand.

I felt mild ED today but 1) That could've been the topical fin I used 2 days before, or 2) a nocebo

Short answer is yes - scalp is much thicker than other parts of the body - and with an open wound there would be a better chance of going systemic- but would depend on how much got in the wound I suppose.