Beware - Lichen planopilaris & hair transplant

[mcr7777]

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....

 

 

[RandoBrando517]

Do you mind showing us pictures? How can we tell the signs that we have it?

[Melvin- Admin]

I talked to Dr. Bisanga a few months ago and he mentioned there are a lot of cases of failed growth that happened because of LPP. 

[anotherhairlosssufferer]

> Following a biopsy I was diagnosed with lichen planopilaris (LPP)

Is this a condition where they can definitively say that you have it (by having more chemicals of a particular kind in your scalp for example) or is it more or a "syndrome" and pretty much it's up to the subjective opinion of the dermatologist?

Also, can it be fixed?

I am sorry you had it and you potentially wasted 1200 grafts (went through your post history - it doesn't look at all bad currently imo). I definitely have itching all over the scalp and I kinda feel that's an indication of where the hair loss is progressing, but I don't know enough about it to make any claims.

 

[ITA]

4 hours ago, Melvin-Moderator said:

failed growth that happened because of LPP. 

@Melvin-ModeratorFailed growth, or as in my case, complete growth of all the implanted grafts, and then fall after just 8 months from the transplant of many of them?

[Melvin- Admin]

25 minutes ago, Egy said:

@Melvin-ModeratorFailed growth, or as in my case, complete growth of all the implanted grafts, and then fall after just 8 months from the transplant of many of them?

Did you get your results?

[mcr7777]

1 hour ago, anotherhairlosssufferer said:

> Following a biopsy I was diagnosed with lichen planopilaris (LPP)

Is this a condition where they can definitively say that you have it (by having more chemicals of a particular kind in your scalp for example) or is it more or a "syndrome" and pretty much it's up to the subjective opinion of the dermatologist?

Also, can it be fixed?

I am sorry you had it and you potentially wasted 1200 grafts (went through your post history - it doesn't look at all bad currently imo). I definitely have itching all over the scalp and I kinda feel that's an indication of where the hair loss is progressing, but I don't know enough about it to make any claims.

 

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.

 

 

 

[ITA]

5 hours ago, Melvin-Moderator said:

Did you get your results?

@Melvin-ModeratorYes, no lichen from the report, you haven't read my thread 😡? 

[Melvin- Admin]

13 hours ago, Egy said:

@Melvin-ModeratorYes, no lichen from the report, you haven't read my thread 😡? 

Oops haha 😆 I need to go and read it. I’m intrigued as to what may have happened.

[Cory]

On 2/11/2021 at 1:34 AM, mcr7777 said:

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.

Hi, sorry to be late on this thread, but I'm curious..

Would this also mean that parts where lpp isn't present (or noticeable under a microscope from biopsy), there wouldn't be a risk of rejecting existing or new-implanted follicles? Or only increased risk at that particular part of the scalp?

I'm wondering if lpp can be confused with 'regular' folliculitis, or if there is a very clear distinction.

[HairEnthusiast101]

Interesting this needs to be more known. I bet a higher percentage of people have it than any number could guess. Even when I look it up not much is discussed about it. So thinning eyebrows and all day scalp itching is the major symptoms? I feel I deal with both. My dermatologist doesn’t seem to examine my hair very hard but I will call to be on the safe side. I am thinning more so it could be a reason why. Is there a cure for this?

Edited March 22, 2023 by HairEnthusiast101

[mcr7777]

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.

 

 

 

[Silent123]

2 hours ago, mcr7777 said:

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.

 

 

 

Hey man, this is interesting. Autoimmune disorders are such a strange phenomenon that I'm surprised there is still no actual cure after all this years. Treatments work, but as soon as you stop, oh no !

[MattJosh]

3 hours ago, mcr7777 said:

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.

 

 

 

This is very interesting

Let me ask you something, do the hairs that fall because of LPP regrow a few months later??? Or once hairs fall because of LPP they never come back?

What is your experience and opinion on this?

[mcr7777]

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.

 

[mcr7777]

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.

 

 

[stephcurry30]

thank you for posting this. I will reach out to a dermatologist for this test/biopsy!

[MattJosh]

On 3/23/2023 at 3:37 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.

 

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

[mcr7777]

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.

Edited March 28, 2023 by mcr7777

[HairEnthusiast101]

Is there any family history or any known potential causes for this? When I search online it says it mainly affects women. Probably tons of information not really known on it at this point 

[MattJosh]

11 hours ago, mcr7777 said:

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.

Ok it makes sense now

Since you had it, how did you treated it? Any success?

[Jayson1361]

On 2/10/2021 at 7:39 AM, mcr7777 said:

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....

 

 

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. 

Edited March 30, 2023 by Jayson1361

[Henry]

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?

[Jayson1361]

I’ve looked into this before. Posting twice in this thread I wanted to say I think it’s important to keep things in perspective. LPP with associated FFA is rather rare even for those who have an auto immune disorder like lichen planus or perceived symptoms that coincide with mpb. To say that allot more people have it than has been reported or diagnosed is a stretch I feel. Almost all of the normal symptoms of MPB can be associated with LPP and FFA or a patterned form of fibrosis. Itching, receding hairline, change in hair texture… thinning eyebrows, or sideburns would probably be more indicative of something but itching…meh that can be caused by so much, including folliculitis or any number of things. Discoloration on a small scale occurs in almost all skin types as well. That was my conclusion originally when looking  into this and it remains the same. Further, having dealt with lichen planus it’s not permanent on any part of the body in my experience and can flare up or not. If indeed there is hairloss due to LPP I would think that might even be a better diagnosis than MPB as symptoms can be controlled and eventually eliminated even. Further HT can take in areas where there is scar tissue as that resides on the top of skin. But, that being said Hair loss due to scar tissue is very permanent and destruction of stem cells in the bulb is also, at least for now. Healthy grafts finding a blood supply would take quite some time to be impacted by LPP as they were not impacted most likely prior to the HT on the back of the head. Obviously LPP can be localized but usually does fade with time to virtually non existent. I had an injury a scrap that was fell on my hands due to moving heavy furniture during a move. I had what I think was a version of LP that existed for 2.5 years before disappearing. Super dry skin, perceived eczema or something. Eventually it subsided to let’s say a .5 vs a 10 and has remained as such. JAK inhibitors have been shown to significantly improve LP and LPP as well…. which means that dealing with hairloss outside of androgens could have a higher probability of success when associated with HT. Personally I think drugs associated AA vs MPB have a higher chance of success of coming to market much sooner. Whose to say really, but it’s important to keep things in perspective. Sure the OP has a biopsy and diagnosis, but I bet with treatment if indeed that was the only form of hairloss… 1) The LPP will eventually subside and 2) drug intervention has a higher chance of success vs MPB drugs over time. Sure not knowing ahead of time and getting a HT without treatment of an underlying condition is alarming, but knowing ahead of time and treating and with time, and assuming that were the only cause of hair loss…I might take that over MPB. I bet treatment of LPP and another pass via HT would yield positive results. Curious as to what an ANA blood test reveals for the OP? That’s standard ops for a blood test when getting a yearly physical. 
 

There is a pub med study that shows LPP causes a positive ANA test in 84% + patients. 
 

https://pubmed.ncbi.nlm.nih.gov/30810113/

 

Further, when it comes to speculation on hairloss, this site is more prone to speculation vs empirical observation or evidence due to the personal nature of hair loss.  Based on that I think it would be safe to assume in the absence of  a positive ANA test or positive biopsy HT would still be the gold standard in dealing with hair loss even if LPP or FFA is suspected or even found. Obviously if either were found treatment associated with HT would be the obvious course. 
 

I think it’s also fair to note that fibrotic tissue regardless of scarring is also prevalent in MPB as well as FFA. The obvious difference being that FFA can have a skin level scarring bulb and in extreme cases a keloid that grows to be much much larger although very rare and even more so in men. Point being just because LPP is present doesn’t mean time and circumstance associated with treatment and HT can’t yield a positive result. The crux of this being that it may take longer and or preserving donors for a later date. 
 

Lets also not forget there have been many post on scar tissue from FUT being repaired as well in this forum. Which I bet is much more fibrotic than an unnoticed form of FFA associated with LPP. 

Edited March 31, 2023 by Jayson1361

[mcr7777]

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.