Diagnosed with mix of male pattern baldness and LPP. Please, highly appreciate advice.

[Gert]

Dear all,
Been losing hair since 2017 and have seen 4 dermatologists prior to find a hair specialist.

In 2019 I had a biopsy which diagnosed me with early stages of Lichen Planopilaris.
I took topical cortisone cream and cortisone pills and I (think) I had some improvement.
However after those treatments I started with a laser helmet (which according to studies would help) but my hair got worse.

In 2020 I finally find a hair loss specialist who said my LPP seemed not (very) active and I had miniaturised hair and clearly signs of MBP.

I've been on Minoxidil since summer 2018. TOP Pictures are 4 months in, BELOW pictures are 8 months in.
No improvement and my left temple got a bit thinner, but exactly on the hairline it got bad. Right temple is not great either though.
Seems to me Minoxidil left me worse off and this triggered my depression.

- Laser treatment LLLT and Minoxidil seemed to make my hair worse on the hairline and temple. Both used 8 months. Any experience with this? Is it possible to shed the thin hair, as it should, but never regrow?
- Judging from my case, can I be a good candidate for finasteride, even I am not a minoxidil or LLLT responder?

Thanks!

 

[Pls_NW-1]

Finasteride WILL work. It drops DHT level on scalp by 1/2, so you will slow your balding process by 1/2 to 1/3.

There is no way you CAN'T respond to finasteride well.

People, who say that they don't respond to finasteride well, is because that their hair loss is just slowed down and not stopped, because of the aggressivness.


Hope this clarifies.

-> Finasteride just slows down hair loss,
doesn't stop.

 

[Gert]

Thanks for your reply!
Concerning minoxidil. I'm sure it is making my hair worse, especially on the hairline. Could that be?
After 8 months, it seems advisable to stop? As it is well over the 4 or 6 months that people see some benefit.

 

[Pls_NW-1]

Thanks for your reply!
Concerning minoxidil. I'm sure it is making my hair worse, especially on the hairline. Could that be?
After 8 months, it seems advisable to stop? As it is well over the 4 or 6 months that people see some benefit.

I would consider trying to refresh the immune system with a better diet and try other stuff to stop mob progression. Minoxidil is only a growth stimulant, it doesnt stop male pattern baldness.

 

[Selb]

It could be that minoxidil is making your hair worse because you have LPP.

https://donovanmedical.com/hair-blog/2017/7/10/Androgenetic Alopecia-or-lpp-who-is-right

Also biopsies aren’t definitive. It might be that you have Androgenetic Alopecia. Either way, if your disease is inactive and your have progressive thinning, finasteride is what you want

 

[Jacoby77]

I'm on the same stage. I think I have male pattern baldness, parting is the exact same as yours.

Really makes me depressed and have bad thoughts as I'm not the best looking so I won't suit bald. Scared to go on finasteride, gonna try see a trichologist for confirmation. Life sucks.

 

[Gert]

Hi man, sorry to hear you're depressed.
I am as well. The year sucked. I broke up with my LDR girlfriend after 2.5y (due to COVID) and it adds to the overall depression.

I'm reluctant to try finasteride as well.
My urologist will check my semen, my blood work will be done and actually my DNA is being checked by Fagron to see if finasteride or any other kind of medication might work for me. All to help to make a decision to take finasteride.

 

[Selb]

Hi man, sorry to hear you're depressed.
I am as well. The year sucked. I broke up with my LDR girlfriend after 2.5y (due to COVID) and it adds to the overall depression.

I'm reluctant to try finasteride as well.
My urologist will check my semen, my blood work will be done and actually my DNA is being checked by Fagron to see if finasteride or any other kind of medication might work for me. All to help to make a decision to take finasteride.

Interesting to hear about Fagron. Do you live in the US? How did you go about getting Fagron to check your dna?

 

[Gert]

No I live in Belgium. My DNA sample swab has been send by my hair specialist to Fagron Spain.
It costs quite a lot but I'm kinda very worried about taking finasteride and the result should show my 5AR activities.
Also quite positive that minoxidil is not helping and the results should also show if I am missing that enzyme that should convert minoxidil to it's active form. I wanna know if I should drop minoxidil or I need to take a stronger % + perhaps tretinoin as my doctor told me.
I wanna take as less stuff as necessary. No point in taking stuff that your body doesn't respond to.

 

[Gert]

I would consider trying to refresh the immune system with a better diet and try other stuff to stop mob progression. Minoxidil is only a growth stimulant, it doesnt stop male pattern baldness.

I've had my blood checked by a Orthomoleculair specialist who checked my allergies and stuff. This was more than a year ago and have changed my diet for the better ever since. What kind of other things would you recommend? I understand minoxidil is only a growth stimulant. Sadly it is the first line of action in a country as Belgium. I know it doesn't solve the issue but I feel it has accelerated my loss on a specific spot on the hairline where I apply the most.

 

[Selb]

No I live in Belgium. My DNA sample swab has been send by my hair specialist to Fagron Spain.
It costs quite a lot but I'm kinda very worried about taking finasteride and the result should show my 5AR activities.
Also quite positive that minoxidil is not helping and the results should also show if I am missing that enzyme that should convert minoxidil to it's active form. I wanna know if I should drop minoxidil or I need to take a stronger % + perhaps tretinoin as my doctor told me.
I wanna take as less stuff as necessary. No point in taking stuff that your body doesn't respond to.

Agh I’m jealous. I emailed Fragron US and they don’t offer it. I’m hoping I can do it through Fragron UK.

 

[Gert]

It could be that minoxidil is making your hair worse because you have LPP.

https://donovanmedical.com/hair-blog/2017/7/10/Androgenetic Alopecia-or-lpp-who-is-right

Also biopsies aren’t definitive. It might be that you have Androgenetic Alopecia. Either way, if your disease is inactive and your have progressive thinning, finasteride is what you want

I actually bought a microscope to check my scalp and I could see that I didn't lose any hair per se, but that my hair is thinner. So finasteride is probably what I need. I'm not sure if I should use oral or check our topical.

 

[Selb]

I actually bought a microscope to check my scalp and I could see that I didn't lose any hair per se, but that my hair is thinner. So finasteride is probably what I need. I'm not sure if I should use oral or check our topical.

Wanted to bump this topic. In your early report lichen Planopilaris, do you still have the biopsy findings? I wanted to see what they put in the summary report and compare it to mine.

For me they said mild focal perifollicular fibrosis, single free hair shaft, mild focal lichenoid cell infiltrate, and some hyper keratosis with mild hypergranulosis. Subtle signs of lichen planopilaris

 

[Gert]

Yeah, I still have the report but it's not in English so forgive me for a possible bad translation of these medical terms...

Around multiple follecular infundibula there is centric fibrosis present and a mild lymfocytair infiltrate. At the follecular interfase there are small lymfocytes. Mild peri-infundibulaire fibrosis.

Suggestion that it is an early stage of LPP because of the peri-infundibulaire fibrosis.

 

[Selb]

Yeah, I still have the report but it's not in English so forgive me for a possible bad translation of these medical terms...

Around multiple follecular infundibula there is centric fibrosis present and a mild lymfocytair infiltrate. At the follecular interfase there are small lymfocytes. Mild peri-infundibulaire fibrosis.

Suggestion that it is an early stage of LPP because of the peri-infundibulaire fibrosis.

Thanks. Yeah that seems fairly similar to mine. Lichenoid isn’t mentioned but the key idea is mild fibrosis or scarring. I’m taking oral min to maximize growth around the thin spots on my scalp which I assume are the scarred areas. And hope that doxycycline and my topical steroid give me some regrowth

 

[Gert]

Thanks. Yeah that seems fairly similar to mine. Lichenoid isn’t mentioned but the key idea is mild fibrosis or scarring. I’m taking oral min to maximize growth around the thin spots on my scalp which I assume are the scarred areas. And hope that doxycycline and my topical steroid give me some regrowth

I was on topical steroid for about 3 months. It didn't help the redness but I felt my hair growth was better. Not very sure though. It's a feeling.

I never tried doxycyxline or oral min.
I was proposed hydroxychloroquine but it has effects on your immune system which, with covid around, wasn't the best idea according to my doctor.

How are the meds working out for you and how long have you been on them?

 

[Selb]

I was on topical steroid for about 3 months. It didn't help the redness but I felt my hair growth was better. Not very sure though. It's a feeling.

I never tried doxycyxline or oral min.
I was proposed hydroxychloroquine but it has effects on your immune system which, with covid around, wasn't the best idea according to my doctor.

How are the meds working out for you and how long have you been on them?

I haven’t really noticed much difference yet from the steroid and doxycycline. It’s gonna take another month or two before I can assess I guess. I’m going to incorporate tacrolimus too

 

[Gert]

I haven’t really noticed much difference yet from the steroid and doxycycline. It’s gonna take another month or two before I can assess I guess. I’m going to incorporate tacrolimus too

Where are you losing your hair if I can ask? Predominantly from the top or also sides and back?

Be sure to be extra careful with covid around if you're gonna take immunosuppressants. Your body will be in a lesser state in the unfortunate event you got an infection.

 

[Selb]

Where are you losing your hair if I can ask? Predominantly from the top or also sides and back?

Be sure to be extra careful with covid around if you're gonna take immunosuppressants. Your body will be in a lesser state in the unfortunate event you got an infection.

From the top for the most part. I have some hair loss on the sides as well. My guess is that accutane messed with my sebaceous gland function and triggered diffuse LPP. But that’s just a guess unfortunately.

I’m hoping tacrolimus won’t go systemic and I localize the immune suppression to just my scalp. Maybe I should try to get a vaccine

 

[Notdifferent]

Finasteride WILL work. It drops DHT level on scalp by 1/2, so you will slow your balding process by 1/2 to 1/3.

There is no way you CAN'T respond to finasteride well.

People, who say that they don't respond to finasteride well, is because that their hair loss is just slowed down and not stopped, because of the aggressivness.


Hope this clarifies.

-> Finasteride just slows down hair loss,
doesn't stop.

U srsly saying that finasteride works 100% of the time?
lol