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Lichen planopilaris - Scarring alopecia - Hair transplant

F

Foody

member
I am wondering if anyone has experience dealing with lichen planopilaris - scarring alopecia or similar conditions. Some of the symptoms I have include redness, itching, flaky scalp, and a burning sensation. However, it is very sporadic in that it randomly appears and goes after several weeks. I had a clinical evaluation from a dermatologist who prescribed medicated shampoo and steroid cream. This helps to ease the symptoms, but I cannot help thinking that she should have arranged a scalp biopsy. All my symptoms indicate LLP or SA, Now in two minds to source another medical opinion.
My hair has been thinning with a diffuse pattern, no complete bald spots. This could be why the Derm did not think it was one of the above.
Right now, a hair transplant is something that could restore my hair, but I have read conflicting theories that state not suitable and others say suitable if not that serious. Has anybody in the community went ahead with these conditions?
The hair around the back and sides is not affected. If this hair is moved to the top will it be resistant to LLP or SA?
 
Bigmac

Bigmac

Administrator
Staff member
Hi Foody, welcome to the forum. From what you describe it does sound like one of the conditions you’re asking about or possibly non scarring alopecia.
In non-scarring alopecia, the follicles are still alive with only the hair shaft missing. In scarring alopecia, the stem cells in the bulge/bulb area are killed off and replaced by fibrous scar tissue which results in permanent hair loss. It is possible you have the non scarring version. This may be the reason a biopsy was not mentioned and medications recommended. By all means consult with someone else if you’re not completely satisfied.

You could set up an in person consult with a hair transplant doctor. Have them check your scalp and advise if they think you’d be a candidate for surgery. Lpp and scarring alopecia can lie dormant and then return if the scalp suffers trauma. It really is a risk that the growth could fail or you could have a successful surgery only for the hair to be lost later. The hair from the donor area will not be resistant. Ask your dermatologist what she thinks is the underlying issue and mention that you’re considering a hair transplant.

I hope you can find some resolution.
 
F

Foody

member
Bigmac, I reached out to several clinics with varying answers. One mentioned they will offer surgery if I have the condition stabilized - under control. I heard back from my Derm, she said in her professional opinion I only have Seborrheic Dermatitis. I say only because the latter is not as serious as Lpp.
Now I am thinking should I go for it? What do you think?
 
F

Foody

member
I am still weighing up my options. Whilst looking for answers I found articles by Dr. Jeff Donovan. ( I am unable to add the link ) What do you think Bigmac?

The article is below in its entirety :


A hair transplant is always an option for treating scarring alopecia, especially if medical treatments don’t work.

Let me begin by saying that hair transplants for scarring alopecia can sometimes be a good idea. Some patients have very nice results. It can be life changing.

But it can sometimes be a bad idea. The decision ranges from being a good idea to being an okay idea to being a bad idea to a very bad idea depending on the clinical information of the patient and the current disease activity. Sometimes a hair transplant works out really well and patients are pleased with the outcome, but sometimes it does not work out well at all. Sometimes, a hair transplant actually even worsens things such that a patient would have been much more satisfied if they never had a hair transplant in the first place.

I know this doesn’t get talked about alot. And so I’m talking about it today.

A hair transplant is never a fantastic option for scarring alopecia. A patient with scarring alopecia is never an excellent candidate for surgery. Don’t be mistaken though - a hair transplant can sometimes be a good option and a patient can be a good candidate for surgery. But “good” and “fantastic” are very different. A fantastic or excellent option would mean that surgery is guaranteed to work great and transplanted hairs will last forever and ever and someone can just be done with all the medical treatments. No, having a transplant does not come with these types of guarantees. I wish it did, but it does not.

A more balanced view is appropriate. If a patient or physician thinks that hair transplants are just a perfect option for scarring alopecia, you haven’t seen or heard enough complications.

A patient with scarring alopecia can only undergo a hair transplant if they meet a few basic criteria. They need to a) have inactive disease for ideally two years or more before undergoing a transplant b) understand that the transplant may or may not work out successfully c) understand that the transplant may work out incredibly well after 1 year or even at the 2 or 5 year mark but then some or all of the grafts might be lost in years beyond that d) be prepared for the possibility of a “flare” or worsening of disease after the transplant and have a dermatologist on board to step in to improve the odds to quickly stop the flare.

A hair transplant is most certainly on the list of treatments for inactive burnt out scarring alopecia. Don’t misconstrue this post in any other way. But it’s only an option for the well informed patient who has long standing inactive disease who works with a hair transplant surgeon with experience transplanting scarring alopecia. Rushing into a hair transplant while the disease is active is likely to lead to problems.
 
Bigmac

Bigmac

Administrator
Staff member
Hi Foody.
Only you can decide if you want to risk surgery. I have seen hair transplants fail because underlying issues were activated due to scalp trauma. Have you had an in person consultation with a doctor who specialises in hair restoration?
Thats a good article by Dr Donovan. The inactive stage and flare up possibilities are what will concern most doctors.
If you search the forum for scarring alopecia or lichen planopilaris, you will find some information about it and some patients who have the condition.
 
F

Foody

member
I had online visual consultations that were helpful with all warning about the possible risks. I guess it is down to me on my next move. The clinic who agreed I could have surgery I have kinder disregarded, they are somewhat unknown, and provide a multitude of other cosmetic procedures.
Thanks for the advice!
 
Techno1

Techno1

member
If it is seborrheic dermatitis you should have it under control before a hair transplant. Be careful when using harsh shampoos such as Nizoral, once a week for this shampoo. Washing your hair daily with a medicated or dandruff shampoo will help. T-gel therapeutic shampoo is very good.
Seborrheic dermatitis is a lifetime condition. Your dermatologist should provide you with a fact sheet and recommendations to keep it under control. Once under control, zero inflammation and flakes, a hair transplant will be capable of working successfully.
 
S

smokeybacon

member
Hi foody, I hope you get some closure on this. It is interesting but sure you don´t see it that way. If I understand it. So, it´s possible to have no signs of this and have a hair transplant and it´s possible the hair may not grow, and a test after could then only show the condition. If that is right it would be interesting how common this is, are some people more likely to have it than others, like age, ethnicity etc. I hope you get to the bottom of things.
 
Scott Medikemos

Scott Medikemos

Valued member
We had experience of this, at the time we were not aware until after. The growth was not what we expected, the scalp was examined via a biopsy and found to be llp.
 
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