mcr7777

That's good you have no thinning at least. TE usually affects the whole scalp but there can be localised TE sometimes but there is usually some underlying cause. Dr Donovan (specialist hair doctor) talks about it. If it continues for some time you might want to see a specialist hair dermatologist - but if no thinning that is a plus.

Do you notice actual thinning of the hair? or are small numbers falling and regrowing that it doesn't appear thinner than before. I suppose it could be a number of things e.g. telogen eflluvium?_ - but would normally affect entire scalp rather than just transplanted hairs

Do you know why your previous surgury failed? If I were you I'd want to rule out an autoimmune condition through a specialist hair dermatologist before considering any further surgery.

I'm thinking a good thing to do is to investigate/rule out autoimmune conditions e.g. alopecia areata or lichen planopilaris (LPP). Do you have any itching/burning/crawling sensations?

I'm sorry to hear the hairs are thinning rapidly. Do you have any itching/tenderness/crawling sensations on the scalp?

Do you have any Do you have any burning/tenderness sensations on the scalp?

If you have itchy scalp - you should definitely check that you don't have Lichen planopilaris -an autoimmune condition. This is what I have - it causes an itchy scalp with hair loss - which can be patchy or sometimes diffuse or other times in a vertical strip down the centre of the head. People with LPP are often misdiagnosed as MBP. For this reason, you should find a derm specialising in hair loss - not a general derm - and not just a HT doctor- as they often will miss LPP/not be very aware of it. If you think you might have LPP i'd suggest trying to find a derm that knows about scarring alpoecia. It's not uncommon for people with LPP to also have some MBP which seems to confuse doctors. I'd recommend trying to find what is causing the thinning and itchiness before doing another transplant. Meds might help to stabilise your hair - but LPP meds are oten different than MBP mesd. So important to find out what is going on if you've lost a lot of hair very quickly. The itching and quick thinning makes me suspicious of LPP - but you need to see a dermatologist to figure out what's wrong rather than a HT doctor.

It looks like you have red pimple type bumps on your hairline - have you been checked for some type of scalp condition e.g. dermatitis by the clinic or a dermatologist? Might be a good thing to do as it looks unusual.

Have you noticed any sides from Topical dut? Do you think it's working? Any shed with it?

HT clinics would not be able to diagnose LPP - certainly online - and even in person. I saw several clinics in UK and none of them recognised I had LPP. You could always invest in a digital microscope like I did - £18/25 USD on amazon. You can look at your scalp and see if there are typical LPP symptoms like redness around the follicles, scaling etc. A quick Google search will show you what LPP looks like on dermoscopy. It's acutally probably more reliable as a first step than seeing a general derm (many who are not great at spotting LPP as many forum users go years being misdiagnosed).

I'd definitely would recommend seeing a specialist derm before going with a HT. I saw a number of HT doctors including former derms who didn't recognise I had LPP even though I had symptoms and hair loss. I ended up getting a HT and getting diagnosed with LPP afterwards - after itching/burning didn't stop and growth wasn't great. I wish I'd known beforehand but didn't see a specialist derm - and didn't even realise LPP existed. Do you have symptoms e.g. ithching/burning?

It might help a touch with itching but it's not one of the main treatments I find other shampoos better for soothing the scalp. You might want to try Euracin shampoo or head and shoulder anti itch as they helped me while I was waiting to be seen by a derm. If it is LPP you have or a scarring alopeia, more targeted meds are needed if you want to bring down inflammation.

No hair doesn't grow back if lost to LPP - that's why it's important to get diagnosed early if you think you might have it. A lot of people seem to be completely unaware of lichen planopilaris (like I was) and even derms and doctors frequently misdiagnose it. The digital microscope is useful as there are certain details you can see only with the microscope (e.g. scale around the follicles). Seb derm is another possible cause but I don't think this generally causes as much hair loss and maybe less intense pain/burning compared with LPP.

I am on lymcecycline and topical steroids and have just started hydrochloroquine too. No sides form these (unlike fin which made my condition a lot worse and caused sides). I'd suggest seeing a dermatologist that specialises in hair loss - ideally one that knows about scarring alopecias. A lot of people seem to get misdiagnosed due to ignorance of many general derms about the condition. This means treatments are delayed and lots of hair is lost before a diagnoses is made - this happened in my case. It wasn't until I got the digital microscope that I realised myself what it was. You don't regrow hair from LPP loss so suggest getting diagnosed as quickly as you can if you think it might be what you have.

I'd definitely recommend getting a dermatologist/hair specialist to examine your scalp for signs of inflammation. I had the same as you and was diagnosed with lichen planopilaris. Treatments are needed to stop shedding (mine is finally getting better). You can even buy a digital microscope on amazon for about £18/less than 20 USD. You should be able to see if there are worrying signs like redness around the hair follicles.

You might want to see my recent post - I was diagnosed with LPP a year after having a HT - I basically didin't know it was LPP causing hair loss until a year after i did the HT. The HT didn't grow great as they implanted into an area of active LPP (maybe frontal fibrosing). I do have more hair there now but not expecting to keep them more than a year or so longer as the LPP will probably kill them. If I want more hair I think I'll have to go down the hair system route. Was your biopsy showing LPP in the front, (frontal fibrosing) and/or middle or crown?

The biopsy takes a small bit of your scalp including hair bulb. They need to take it in an area of active inflammation in order to do a proper diagnosis. The derm normally takes the biopsy and sends it to a specialist lab where they analyse it. They gave me a technical report which analyses the hairs and root and whether it is growing properly. LPP kills the stem cells so hair bulb can't regrow. If you think you might have it (any of the symptoms I mentioned e.g. eyebrow thinning or pale patches around hair loss or forehead), it's important to go to a derm who deals with hair loss and knows about scarring alopecia. They need to take the biopsy in the right area of active LPP - as if they take from an unaffected part of the scalp the biopsy probably won't show anything and you may be misdiagnosed.

You might want to see my recent post - I was diagnosed with LPP a year after having a HT - I basically didin't know it was LPP causing hair loss until a year after i did the HT. The HT didn't grow great as they implanted into an area of active LPP (maybe frontal fibrosing). I do have more hair there now but not expecting to keep them more than a year or so longer as the LPP will probably kill them. If I want more hair I think I'll have to go down the hair system route. Was your biopsy showing LPP in the front (frontal fibrosing) and/or somewhere else on the scalp?

I thought I would update my case as I had a hair transplant 1 year ago with sub-par growth. Following a biopsy I was diagnosed with lichen planopilaris (LPP) - most likely the frontal fibrosing variant, a scarring alopecia -last week. This means after going through a HT, my transplanted hairs will likely fall out in the coming months/couple of years. I had no idea this condition even existed until two months ago. I saw 4 different HT doctors before my procedure and none mentioned I might have this condition. It does look similar to MBP - but now that I've read about frontal fibrosing, I can spot some differences in the symptoms: very itchy scalp at area of hair loss, some minor eyebrow thinning which I do have - but didn't notice until I really looked back at photos of my eyebrows 5 years ago when they were much thicker. I wanted to warn people that if you have an itchy scalp/inflammation, eyebrow thinning you might want to see a dermatologist before going for a HT. Another sign of FFA/LPP is paler white skin pigmentation around the area of the hair loss - that might extend a bit down the forehead- it looks unaffected by sun damage/colour and might make the rest of your forehead look darker. Although not everyone gets this. I also have this for 5 but had no idea it was LPP/FFA and only one of the doctors spotted it (I have pale skin to begin with so may have been difficult) but didn't mention FFA/LPP. Some men also get sideburn thinning but I don't have this. I wish I'd known about this condition beforehand. They say frontal fibrosing is very rare in men - but I've read it's likely way under-diagnosed due to similarities with MPB - and the condition is increasing rapidly. There is speculation some environmental factors e.g. sunscreen or moisturisers might be causing the rapid increase. It mainly affects older women but I read more men are getting it and men tend to get it at younger ages than women. I really wonder how much these conditions are going undiagnosed in men as it can look a lot like MBP (whereas in women it would be very obvious something is unusual). I also wonder how much poor growth after HT might be attributed to lichen planopilaris/frontal fibrosing. I would have never known I had it - had it not been for lots of internet research and eventually seeing the dermatologist to get the biopsy. Hope this might help someone out there....

Can you post one of the centre of the hairline too? Seems like it could be a number of things based on the bumps and inflammation -there may also be some minitaurisation too from what I can see. But don't think you would normally get bumps like that from only MPB. It's possible there can be another condition going on in addition to MBP. Good idea to do a biopsy when you can - definitely before moving forward with any HT.

Yes post pics if you can...sometimes scarring alopecias can look like MPB, especially cases of frontal fibrosing. I really wonder how many go undiagnosed. It cause itching too. Also sometimes you can have both MPB and a scarring alopecia at the same time.

I've had this alot too. Have you tried Ketocozanole shampoo e.g. Nizoral? Could be sebborheic dermatitis. Or possibly a scarring alopecia e.g. lichen planopilaris or Frontal fibrosing. You might need a biopsy to diagnoses these. Try going to a dermatologist that specialises in hair/scalp conditions as general dermatologists often don't know much about these conditions.

Definitely do a biopsy (don't have to wait - can do this now) - it will be worth it to rule out any scarring alopecia which generally causes bad growth (lichnen planopilaris, frontal fibrosing, etc) Don't even think about a touch up without getting a biopsy and understanding what went wrong.

Have you seen a dermatologist? They can examine for any signs of a scalp biopsy (e.g. scarring alopecia Lichen Planopilaris, Fibrosing Alopecia etc). These conditions normally cause transplanted grafts to shed after 15 months- 2+ years. They can sometimes be mistaken for MPB. Definitely worth doing especially if you're considering another procedure.

Yes - I agree - I am concerned myself about having frontal fibrosing/lichen planopilaris - already nearly a year into my transplant and waiting to have a biopsy now. Wish I'd known about these conditions before and had one before my transplant so I could have had more peace of mind. I think some HT doctors aren't very aware of frontal fibrosing (FFA) and how much it can look like normal MPB - and certainly general public don't seem to be very aware of it.