Beware - Lichen Planopilaris, Frontal Fibrosing & hair transplant

[hairhelp777]

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 hair transplant, 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 hair transplant 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 hair transplant. 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 male pattern baldness - 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 hair transplant 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....

 

[Selb]

Sorry to hear you have that condition. I did have a biopsy that showed LPP, but it’s also commonly mistaken for male pattern baldness since inflammation is observable in both types of alopecia. I’d much rather have male pattern baldness tbh

 

[hairhelp777]

Hi Selb- thank you for the note. Did your LPP stabalise and where on your scalp was it - front, mid or crown? Have you taken treatment for it? I am currently taking topical steroids which helps the itchiness. My derm also prescribed lymecycline antibiotic to help the inflammation.

 

[trialAcc]

What else did you get to treat it? I've wondered if I've had this for awhile now due to the pain on my scalp when the shedding occurs. 90% of my loss is at the front too but obviously the google pictures are all so severe it's impossible to tell. If I pull at my eye brows loosely I get 4-5 hairs each time.

Unfortunately my city is basically shut down right now due to covid and I can't get into see a derm.

 

[hairhelp777]

I've just started antibiotics (lymecycline) to bring down the inflammation. I will probably start hydrochloroquine too at some stage. yes the google photos are all severe cases of FFA but there are plenty of non severe cases that can look a lot like male pattern baldness. Hence all the hair transplant doctors didn't spot- so I didn't know until I had the biopsy done.

T

What else did you get to treat it? I've wondered if I've had this for awhile now due to the pain on my scalp when the shedding occurs. 90% of my loss is at the front too but obviously the google pictures are all so severe it's impossible to tell. If I pull at my eye brows loosely I get 4-5 hairs each time.

Unfortunately my city is basically shut down right now due to covid and I can't get into see a derm.

Have your eyelashes thinned e.g. looking back at photos from a few years ago are they thinner? I wish I'd seen a derm earlier but at least know I know what it is.

 

[trialAcc]

I've just started antibiotics (lymecycline) to bring down the inflammation. I will probably start hydrochloroquine too at some stage. yes the google photos are all severe cases of FFA but there are plenty of non severe cases that can look a lot like male pattern baldness. Hence all the hair transplant doctors didn't spot- so I didn't know until I had the biopsy done.

T

Have your eyelashes thinned e.g. looking back at photos from a few years ago are they thinner? I wish I'd seen a derm earlier but at least know I know what it is.

Tough to tell because I have some huge eye brows still. I should see a derm just incase though.

How treatable is it longterm compared to male pattern baldness?

 

[hairhelp777]

Tough to tell because I have some huge eye brows still. I should see a derm just incase though.

How treatable is it longterm compared to male pattern baldness?

There aren't cures for either MBP or lichen planopoparis - but there are treatments for both. Finasteride/minx for MBP and a number of things for LPP/FFA such as antiobiotics, hydrochloroquine, topical steroids and some other drugs. LPP/FFA is much rarer but cases are growing rapidly - especially with FFA. LPP/FFA sometimes burns out with treatment or on its own but each case is different.

Scalp pain and tenderness isn't generally caused by male pattern baldness on its own - I wish I'd realised that as I clearly had pain/intense itching which I put down to MBP when it was actually LPP/FFA. There could be other things causing itching but in my case it was LPP/FFA.

 

[Selb]

There aren't cures for either MBP or lichen planopoparis - but there are treatments for both. Finasteride/minx for MBP and a number of things for LPP/FFA such as antiobiotics, hydrochloroquine, topical steroids and some other drugs. LPP/FFA is much rarer but cases are growing rapidly - especially with FFA. LPP/FFA sometimes burns out with treatment or on its own but each case is different.

Scalp pain and tenderness isn't generally caused by male pattern baldness on its own - I wish I'd realised that as I clearly had pain/intense itching which I put down to MBP when it was actually LPP/FFA. There could be other things causing itching but in my case it was LPP/FFA.

The problem with LPP or FFA is that it scars over the follicles. Meaning regrowth is rare. male pattern baldness has the chance of reversing miniaturization with treatment

 

[hairhelp777]

The problem with LPP or FFA is that it scars over the follicles. Meaning regrowth is rare. male pattern baldness has the chance of reversing miniaturization with treatment

Yes LPP and FFA treatment aim is to stop progression rather than regrow lost hair

I've also heard that regrowth on finasteride is pretty rare - and that for most people it just stops progression or slows it down. And it doesn't always work for everyone apparently.

 

[Selb]

Yes LPP and FFA treatment aim is to stop progression rather than regrow lost hair

I've also heard that regrowth on finasteride is pretty rare - and that for most people it just stops progression or slows it down. And it doesn't always work for everyone apparently.

I think it depends on how early you start finasteride. According to studies, more users were in the positive from baseline in terms of hair count. So regrowth isn’t uncommon on finasteride. Maybe cosmetic regrowth is rarer, but there’s some thickness going on.

I’ve also seen cases of LPP regrowth. It requires the use of early intervention and immunosuppressants tho.