Beware - Lichen planopilaris & hair transplant

[Henry]

2 minutes ago, mcr7777 said:

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.

Do you have dandruff too if you don't use products? I'm prone to like huge, huge pimples that hurt and has puss in them sometimes or just really big and red. Do you have those as well?

[MattJosh]

16 hours ago, Jayson1361 said:

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. 

Very astute observations and I would tend to agree with the overall conclusion

I have to mention that the event of skin discoloration takes place quite often to one degree or another in the case of the recipient area in hair transplantation, specially when  the patient gets plenty of sun exposure before a few months go by

Biopsies are very important to detect these things but let's not rule out the human element and the different interpretations by different Dr's of the same results, as has happened far too many times, unless in cases that are extremely clear and straightforward

[Jayson1361]

1 hour ago, MattJosh said:

Very astute observations and I would tend to agree with the overall conclusion

I have to mention that the event of skin discoloration takes place quite often to one degree or another in the case of the recipient area in hair transplantation, specially when  the patient gets plenty of sun exposure before a few months go by

Biopsies are very important to detect these things but let's not rule out the human element and the different interpretations by different Dr's of the same results, as has happened far too many times, unless in cases that are extremely clear and straightforward

Very true. Further if the individual has any amount of hair on the scalp that could block UV rays there is going to be an obvious discoloration from scalp to forehead. Anyone that has shaved their head down can easily see the whiteness of a scalp vs forehead or neck post shaving. I can pull up a close up photo of skin on my arm and see small tracks of white tracing through possibly hyper pigmented skin. Could probably do it on any part of my body. I think the point is can pores from hair follicles been seen even if they are not producing hair on the scalp. 
 

Op had a history of suggesting LPP in many other posts if the thread even indicates an itching on the scalp, why I’m not sure.  Suggesting a rather rare form of alopecia can be very alarming perhaps even misleading, even though I’m sure his intentions are good. However, getting scalp checked by a derm seems it should be standard ops before getting a HT which is probably the best take from this entire post. 
 

Regardless, I have random itches all over my body all day long I scratch and they go away, including my scalp. S$&t I’ve got one right now even🤷‍♂️. Since I comb my hair and don’t care to mess it up so much I just press and release as palpitation also over whelms the nerve registering the itch. 

[HairEnthusiast101]

18 hours ago, Jayson1361 said:

Very true. Further if the individual has any amount of hair on the scalp that could block UV rays there is going to be an obvious discoloration from scalp to forehead. Anyone that has shaved their head down can easily see the whiteness of a scalp vs forehead or neck post shaving. I can pull up a close up photo of skin on my arm and see small tracks of white tracing through possibly hyper pigmented skin. Could probably do it on any part of my body. I think the point is can pores from hair follicles been seen even if they are not producing hair on the scalp. 
 

Op had a history of suggesting LPP in many other posts if the thread even indicates an itching on the scalp, why I’m not sure.  Suggesting a rather rare form of alopecia can be very alarming perhaps even misleading, even though I’m sure his intentions are good. However, getting scalp checked by a derm seems it should be standard ops before getting a HT which is probably the best take from this entire post. 
 

Regardless, I have random itches all over my body all day long I scratch and they go away, including my scalp. S$&t I’ve got one right now even🤷‍♂️. Since I comb my hair and don’t care to mess it up so much I just press and release as palpitation also over whelms the nerve registering the itch. 

Interesting yes I was worried because I’m noticing thinning but my head also itches sometimes throughout the day randomly(probably when I think about it) but also sometimes tingles/burns after showers so I assumed I have this. Which I might but I will get a check regardless. Wonder how common it is

[Jayson1361]

48 minutes ago, HairEnthusiast101 said:

Interesting yes I was worried because I’m noticing thinning but my head also itches sometimes throughout the day randomly(probably when I think about it) but also sometimes tingles/burns after showers so I assumed I have this. Which I might but I will get a check regardless. Wonder how common it is

I think it’s folly to assume one has a rather rare form of alopecia, or I’d go as far to say very rare form of alopecia because the scalp itches or tingles or whatever. I can get my hair to tingle if I push it in the opposite direction it’s trained to feel sore even in the scalp. Probability that I’ve seen from reading online, like all of us….of cases reported of LPP 1-2% are even men. Then FFA would have to develop from that which is even more rare. Especially in men. I could find the links but don’t have them off hand at the moment.  Point is it’s ridiculous to assume one has LPP/FFA from reading on a forum because your scalp itches every so often or tingle when you put pressure on it or whatever. Just ridiculous. 
 

Further, MPB androgen related pattern balding does not just go away and causes permanent fibrotic related baldness.  Lichen Planus or Lichen Planopilaris absolutely can just go away. Or significantly reduce in the presentation of symptoms causing inflammation and hair loss which is essentially what we are talking about.

Edited April 1, 2023 by Jayson1361

[ITA]

1 hour ago, Jayson1361 said:

Penso che sia una follia presumere che si abbia una forma piuttosto rara di alopecia, o direi addirittura una forma molto rara di alopecia perché il cuoio capelluto prude o formicola o altro. Posso farmi formicolare i capelli se li spingo nella direzione opposta, è addestrato a sentirsi dolorante anche nel cuoio capelluto. Probabilità che ho visto leggendo online, come tutti noi…. dei casi segnalati di LPP l'1-2% sono addirittura uomini. Quindi FFA dovrebbe svilupparsi da ciò che è ancora più raro. Soprattutto negli uomini. Potrei trovare i link ma al momento non li ho a portata di mano. Il punto è che è ridicolo presumere che uno abbia LPP/FFA leggendo su un forum perché il tuo cuoio capelluto prude ogni tanto o formicola quando fai pressione su di esso o altro. Semplicemente ridicolo. 
 

Inoltre, la calvizie correlata agli androgeni MPB non si limita a scomparire e provoca calvizie fibrotica permanente. Lichen Planus o Lichen Planopilaris possono assolutamente scomparire. O ridurre significativamente la presentazione dei sintomi che causano l'infiammazione e la caduta dei capelli, che è essenzialmente ciò di cui stiamo parlando.

If, however, to these symptoms, you add that you did one/two transplants and the hair remained on your head only 1-2 or 3 years, some doubt comes to you.

[Jayson1361]

2 hours ago, ITA said:

If, however, to these symptoms, you add that you did one/two transplants and the hair remained on your head only 1-2 or 3 years, some doubt comes to you.

I don’t see the doubt. Don’t transplant hair into an area of active inflammation regardless of the root cause🤷‍♂️. But that’s not the question or doubt I have. I don’t think it’s right to assume that if your scalp itches etc… that LPP/FAA is the first place your mind should go. 

[ITA]

19 minutes ago, Jayson1361 said:

non vedo il dubbio. Non trapiantare i capelli in un'area di infiammazione attiva indipendentemente dalla causa alla radice 🤷‍♂️ . Ma non è questa la domanda o il dubbio che ho. Non credo sia giusto presumere che se il tuo cuoio capelluto prude ecc... che LPP/FAA sia il primo posto dove la tua mente dovrebbe andare. 

It may also be that a person does not know he or she has LPP until after having the transplant.  Sometimes the LPP is so called dormant, there are no symptoms, nor are the surgeons aware of it before or during surgery.

[Jayson1361]

59 minutes ago, ITA said:

It may also be that a person does not know he or she has LPP until after having the transplant.  Sometimes the LPP is so called dormant, there are no symptoms, nor are the surgeons aware of it before or during surgery.

Of course. But the point of my posts are not to address the likelihood of LPP to reoccur after it has become dormant. Rather, I think it’s all reasonable to assume based upon an itchy scalp or other symptoms associated with male pattern baldness or LPP that LPP is the root cause right out of the gate. It will be the last thing that I assume absent a diagnosis.  

[mcr7777]

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.

[MattJosh]

9 hours ago, Jayson1361 said:

I don’t see the doubt. Don’t transplant hair into an area of active inflammation regardless of the root cause🤷‍♂️. But that’s not the question or doubt I have. I don’t think it’s right to assume that if your scalp itches etc… that LPP/FAA is the first place your mind should go. 

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?

[Jayson1361]

8 hours ago, 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?

I think medically, inflammation exists as a matter of verifiable fact and anyone’s definition of inflammation if they are not a medical professional, which I’m not doesn’t matter. But, obviously I’m referencing an underlying disease process or skin condition that’s currently not dormant or is manifesting symptoms. Given that injury can aggravate LPP or LP in skin tissue Id be curious to know if the OP with a diagnosed case of LPP via biopsy has micro needled and if that aggravated the condition. 

[mcr7777]

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

 

Edited April 3, 2023 by mcr7777

[mcr7777]

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.

[mcr7777]

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.

[mcr7777]

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.

[mcr7777]

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.

Edited April 21, 2023 by mcr7777

[ITA]

@mcr7777 what is FFA?

[Britanium]

It’s Frontal fibrosing alopecia (FFA)