Here's a picture and my Punch BIOPSY Results... Now what??

[TGFB1]

Quick Background - Diffuse NW3 ish. 10 years of Dutasteride/Nizoral/minoxidil with ZERO results.

Since I had no luck with Dutasteride/Topical Finasteride/Nizoral/Minoxidil, I thought I would ask for a punch Biopsy. I'm glad I did.

Turns out, I have Perifolicular Lymphocytic Inflammation with background changes of Androgenetic Alopecia(miniaturization).

I Live in Canada so I have some great resources.....Dr Jeff Donovan, Vic Hasson(of Hasson and Wong). I was counselled to try Dermarolling, so I wanted to officially start this as my dermarolling/Microneedling log. Ill be taking pictures and Documenting via Youtube along the way. Any suggestions would be greatly Appreciated. Consider this my Day 1 Picture.

 

[Selb]

Forget about that. Lichen Planopilaris would be diagnosed on like half of the people that do a scalp biopsy. They’re just guessing because of the inflammation which already occurs in androgenic alopecia. If you truly did have it, you wouldn’t be losing hair for ten years. You would have already have huge bald spots with scarring. Clearly your hair loss is just male pattern baldness. You need RU since nuking dht isn’t enough. Plus switch to oral minoxidil

 

[TGFB1]

Forget about that. Lichen Planopilaris would be diagnosed on like half of the people that do a scalp biopsy. They’re just guessing because of the inflammation which already occurs in androgenic alopecia. If you truly did have it, you wouldn’t be losing hair for ten years. You would have already have huge bald spots with scarring. Clearly your hair loss is just male pattern baldness. You need RU since nuking dht isn’t enough. Plus switch to oral minoxidil

Thanks for the suggestion. Oral Minoxidil is not an option for me due to risk with heart problems:

Systemic cardiovascular effects during chronic treatment with topical minoxidil vs placebo were evaluated using a double-blind, randomized design for two parallel groups (n = 20 for minoxidil, n = 15 for placebo). During 6 months of follow-up, blood pressure did not change, whereas minoxidil increased heart rate by 3-5 beats min-1. Compared with placebo, topical minoxidil caused significant increases in LV end-diastolic volume, in cardiac output (by 0.751 min-1) and in LV mass (by 5 g m-2). We conclude that in healthy subjects short-term use of topical minoxidil is likely not to be detrimental. However, safety needs to be established regarding ischaemic symptoms in patients with coronary artery disease as well as for the possible development of LV hypertrophy in healthy subjects during years of therapy.

 

[BuzzedLightyear]

Use tretinoin to enhance minoxidil's effects, needle, use the foam since it contains no PG, and do it twice daily for best results. Like Selb said, use a topical antiandrogen, and the best one we have available is RU. Anything beyond that is probably a tranny drug. Good luck.

 

[TGFB1]

Use tretinoin to enhance minoxidil's effects, needle, use the foam since it contains no PG, and do it twice daily for best results. Like Selb said, use a topical antiandrogen, and the best one we have available is RU. Anything beyond that is probably a tranny drug. Good luck.

Does the PG cause the facial wrinkling and collagen reduction, or is that the minoxidil itself?

 

[DoctorHouse]

Quick Background - Diffuse NW3 ish. 10 years of Dutasteride/Nizoral/minoxidil with ZERO results.

Since I had no luck with Dutasteride/Topical Finasteride/Nizoral/Minoxidil, I thought I would ask for a punch Biopsy. I'm glad I did.

Turns out, I have Perifolicular Lymphocytic Inflammation with background changes of Androgenetic Alopecia(miniaturization).

I Live in Canada so I have some great resources.....Dr Jeff Donovan, Vic Hasson(of Hasson and Wong). I was counselled to try Dermarolling, so I wanted to officially start this as my dermarolling/Microneedling log. Ill be taking pictures and Documenting via Youtube along the way. Any suggestions would be greatly Appreciated. Consider this my Day 1 Picture.

You might just be maintaining so you really can't say you are having zero results. You hair still looks decent enough. You really don't know how bad you would be unless you stop using it.

 

[BuzzedLightyear]

Does the PG cause the facial wrinkling and collagen reduction, or is that the minoxidil itself?

I don't think that PG really does that, but it appears to cause scalp irritation for a lot of people. Minoxidil is supposed to reduce collagen production, though, it should be stated that the study that comes from was done on rats on massive doses. So it probably does have some effect, but the question is how much in a human particularly? Tato talked about this and proposed that as collagen production decreases that elastin production would increase as sufficient compensation. It's really anyone's guess.

 

[BetaBoy]

Was trichoscopic analysis/observation also performed? LPP inflammation has visually unique characteristics in the affected areas of the scalp.

And surely dermarolling/microneedling would be a big no no if you do indeed also have LPP no?

 

[hairhelp777]

Also do you have typical LPP symptoms e.g. itching or burning, tenderness/soreness? Sometimes these come and go - and some people can be symptomless but the majority with LPP do have some symptoms some of the time.

 

[keepcoolmybabies]

Forget about that. Lichen Planopilaris would be diagnosed on like half of the people that do a scalp biopsy. They’re just guessing because of the inflammation which already occurs in androgenic alopecia. If you truly did have it, you wouldn’t be losing hair for ten years. You would have already have huge bald spots with scarring. Clearly your hair loss is just male pattern baldness. You need RU since nuking dht isn’t enough. Plus switch to oral minoxidil

that's actually not quite true. LPP is a very rare diagnosis and doesn't come up in typical biopsy results. You're right in that the biopsy wasn't a definitive diagnosis as other inflammatory conditions have some overlap like folliculitis decalvans or discoid lupus, but it did show symptoms not exactly consistent with non scarring alopecias.

Also 50% of people who have LPP also have concomitant seb derm, which is typically diagnosed first often delaying an LPP diagnosis for years. Not to mention that LPP is a slow moving disease with periods of remission, so the absence of bald spots doesn't exactly mean it doesn't exist and scars aren't typically seen with the naked eye and are more determined by signs like follicular ostia.

Anyway, all this to say that he shouldn't overlook the results as a sham. Yes definitely treat the potential androgenic alopecia, but if he has signs of inflammation at any point then considering the occasional application of a topical corticosteroid like clobetasol might be of great significance to his regimen as well as keeping any itching at bay.

 

[hairhelp777]

Was trichoscopic analysis/observation also performed? LPP inflammation has visually unique characteristics in the affected areas of the scalp.

And surely dermarolling/microneedling would be a big no no if you do indeed also have LPP no?

I agree be careful with dermarolling if you have LPP. It could potentially aggrevate the condition and potentially cause more inflmmation. I've not seen any recommendations for dermarolling in any of Dr. Donovan's recommendations for LPP (I've read his recommendations extensively). Who advised you to dermaroll - I'm guessing it wasn't someone clued up on LPP treatments?