My difficult situation (New Member/First Thread Post)

Raccooner

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I learned that I had male pattern baldness July, 2020. I saw my temples had receded considerably but hardly was aware over the years as I wore my long hair with a center part. It stressed me out and was wondering what I could do to deal with the issue. Three weeks later in mid August, I noticed I began shedding 90 hairs one day and then 120 the next. Previously I wasn't shedding so much. I wasn't aware of seasonal hair shedding so I panicked. It was very hot and dry weather where I was. My body tensed up, muscles were tight and had tension in my body lasting nearly 2 weeks. I also twisted my neck widely, trying to relieve the pressure I had from the tension in my muscles. From the stress of the hair fall I had over those days it resulted in telogen effluvium. Also I had this electric shock tingling numbness in the back of my head on the right side. From medical terminology, it is called "trichodynia" or "scalp dysesthesia." Fast forward to winter 2020/2021, I had taken some Dutasteride to help the condition of my hair. I used the pill for 1 day. There was some unwelcomed hair shedding the next day and bad side effects from the drug, so stopped it immediately. This unnerved me as I was already under so much stress.

The conflict I have now is my hair thinning, particularly on my right vertex section. It is considerably thinner than the left vertex area. I was diagnosed by every dermatologist and trichologist to have male pattern baldness, some also said hair thinning due to telogen effluvium resulting in underlying male pattern baldness. The common male pattern baldness for the area is found in the center vertex in a rounded formation. My bald spot is linear and patchy at times in shape. The fact the baldness has found itself on the right vertex side has me thinking it is not male pattern baldness but some other condition that I cannot determine with perfect certainty. I read the thinning could have resulted from ischemia or inflammation. It could be the stem cells are unable to activate due to the stress shock I had or maybe restriction in blood flow in August 2020. I just fear whatever I did has resulted in permanent hair loss. I asked every dermatologist and trichologist I dealt with if I have scarring alopecia but all have rejected this possibility I present them with. Somehow I don't believe them though given the pattern of hair loss I have. It seems to have common patterns one finds in pseudopelade of brocq or lichen planopilaris. I have not biopsied it and none of the professionals found it suspicious enough to suggest I do one. Other doctors I consulted with; my internist thinks what I have might be alopecia areata, another internal medicine doctor thought it was telogen effluvium caused, a neurologist thinks I have an autoimmune condition which caused the linear hair thinning. I really don't know who or what to believe. I even read the scalp biopsies people get are often inconclusive or inaccurate but it depends where the punches are taken from. Sometimes that's why two rather than one is taken.

Given I desperately want to get my hair regrown in this thinning section I am planning to get platelet rich plasma with adipose (fat derived) stem cell therapy. Not a cheap procedure, 3 treatments are costing U$D $7,900. I just wonder if the treatment will work and hope it won't make my condition worse. Based on my photos, what hair loss condition does it look like I have and what do you think the odds are that the procedure will resolve the thinning issue? Please see my photos. Thanks for reading this post and your time in helping me out. Also if you are a doctor, experienced in the study of hair loss or are a hair specialist please include that information in your reply too.
 

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hairhelp777

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Have you seen a doctor specialised in scarring alopecia? They are the ones most likely to recognise Lichen Planopilaris. Many derms can't recognise it so you need to seek out a specialist if you strongly suspect it. It's very hard to tell from the photos what is might be...but does look unsusual, maybe like AA or LPP. Do you have itching/burning sensations?
 

Raccooner

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Have you seen a doctor specialised in scarring alopecia? They are the ones most likely to recognise Lichen Planopilaris. Many derms can't recognise it so you need to seek out a specialist if you strongly suspect it. It's very hard to tell from the photos what is might be...but does look unsusual, maybe like AA or LPP. Do you have itching/burning sensations?
Thank you for your reply. I've not seen a doctor who specifically deals with scarring alopecia. I know one who does specialize in this but didn't see him. One trichologist ruled out the possibility of it being lichen planopilaris. My internist thought it could be alopecia areata. None of the dermatologists or trichologists I've seen or consulted with thought I had any scarring alopecia even when I mentioned the possibility of it to them. I've seen roughly 1/2 a dozen of them. Every dermatologist/trichologist tells me I have male pattern baldness and some hair loss from telogen effluvium. I do get itching and burning, it's not constant but usually is brought on by stress. The problem is seeing a doctor who deals with scarring alopecia will most likely want to take a biopsy based on the information I tell, ironically which will leave some small (additional) scars. Curious why a regular dermatologist or trichologist wouldn't have the training to recognize such issues? When you mention "AA" you mean alopecia areata and not androgenetic alopecia? The thing is when my scalp is examined by dermatoscope, the follicular ostia can be seen everywhere that has been examined, which points to the possibility of scarring alopecia to be not likely. Some of the ostia have no hairs protruding though, so those might be dormant or dead follicles. Would you think that seeing the number of professionals I have would be indicative of my condition? The doctors I've seen are quite highly rated, experienced and listed by Castle Connolly.
 

JohnSmith21

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Have you seen a doctor specialised in scarring alopecia? They are the ones most likely to recognise Lichen Planopilaris. Many derms can't recognise it so you need to seek out a specialist if you strongly suspect it. It's very hard to tell from the photos what is might be...but does look unsusual, maybe like AA or LPP. Do you have itching/burning sensations?
What do you mean many derms can’t recognize it? A derm is literally the doctor who would recognize it…. There’s no doctors that specialize in just one specific rare derm condition. If the derms say you don’t have that, then you don’t! If your worried, ask one of the to do a biopsy. Simple.
 

infamousrodi

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What do you mean many derms can’t recognize it? A derm is literally the doctor who would recognize it…. There’s no doctors that specialize in just one specific rare derm condition. If the derms say you don’t have that, then you don’t! If your worried, ask one of the to do a biopsy. Simple.
Derms don’t know sh*t, save some time and visit a qualified trichologist. Just saying.
 

jazz1

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male pattern baldness you need the BIG3,

Finasteride
Minoxidil
ketaconazole
 

hairhelp777

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What do you mean many derms can’t recognize it? A derm is literally the doctor who would recognize it…. There’s no doctors that specialize in just one specific rare derm condition. If the derms say you don’t have that, then you don’t! If your worried, ask one of the to do a biopsy. Simple.
That's not correct - there are dermatologists who have special interests in scarring alopecia and hair -and many generalist derms have no clue about the condition and hair in general other than MBP. You normally need to seek out the ones that have a special interest in scarring alopecia. I can recommend some in the UK to anyone that is interested.
There are hundreds of people on the LPP forums e..g 'LPP' let's put out the fire forum' who are misdiagnosed by derms for years before finally reaching a proper diagnosis of LPP -and lose lots of hair in the meantime. I saw several derms and who didn't recognise my condition over several years (even though I had itching/burning) before I was eventually diagnosed by biopsy. Finally on treatment that stops the burning and hopefully the hair loss.
 
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hairhelp777

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Thank you for your reply. I've not seen a doctor who specifically deals with scarring alopecia. I know one who does specialize in this but didn't see him. One trichologist ruled out the possibility of it being lichen planopilaris. My internist thought it could be alopecia areata. None of the dermatologists or trichologists I've seen or consulted with thought I had any scarring alopecia even when I mentioned the possibility of it to them. I've seen roughly 1/2 a dozen of them. Every dermatologist/trichologist tells me I have male pattern baldness and some hair loss from telogen effluvium. I do get itching and burning, it's not constant but usually is brought on by stress. The problem is seeing a doctor who deals with scarring alopecia will most likely want to take a biopsy based on the information I tell, ironically which will leave some small (additional) scars. Curious why a regular dermatologist or trichologist wouldn't have the training to recognize such issues? When you mention "AA" you mean alopecia areata and not androgenetic alopecia? The thing is when my scalp is examined by dermatoscope, the follicular ostia can be seen everywhere that has been examined, which points to the possibility of scarring alopecia to be not likely. Some of the ostia have no hairs protruding though, so those might be dormant or dead follicles. Would you think that seeing the number of professionals I have would be indicative of my condition? The doctors I've seen are quite highly rated, experienced and listed by Castle Connolly.
The LPP forums are littered with people who had LPP but took ages to get it properly diagnosed. the problem is general derms are not used to the condition - and many people with LPP also have MBP so LPP is often missed. the electric shock sensations are pretty unusual. Sorry for AA I meant androgenetic alopecia.

One thing you could do (which I did) was buy a digital microscope on amazon. This will let you see what your scalp looks like e.g. if you have redness in the area,scaling etc. which is typical of LPP. If the scalp is uniformly white that is a good sign. I could tell straight away that mine was highly suspect of LPP - and a biopsy later confirmed it. Digital microscopes are very cheap (£18/25 USD) and you can google lpp dermoscopy to see what typical LPP looks like. General doctors/derms should in theory be able to dignose LPP but I've read so many people on the forums that are misdiagnosed for years and end up losing lots of hair/not having proper treatment because of this.

The biopsy itself shouldn't really make a big difference - I had 2 done in different places - and I struggle to find where the 2nd one is even located. it's a pretty small area and should be small compared to the loss in your vertex. Do you have any loss in the front? Any itching/burning?
 

Jacoby77

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Derms don’t know sh*t, save some time and visit a qualified trichologist. Just saying.
My trichologist backed out on her diagnosis. Disagree here lol. She said male pattern baldness now she said maybe vitamin D deficiency hair loss.

Trichologists are fine but not mine
 

infamousrodi

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My trichologist backed out on her diagnosis. Disagree here lol. She said male pattern baldness now she said maybe vitamin D deficiency hair loss.

Trichologists are fine but not mine
A qualified tric will use terms like follicular units, look for miniaturization ratio of telogen velus to terminal hairs with microscope. Kind of hard to come by unfortunately
 

Diffused_confidence

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My trichologist backed out on her diagnosis. Disagree here lol. She said male pattern baldness now she said maybe vitamin D deficiency hair loss.

Trichologists are fine but not mine
I got consultation with a surgeon and he suggested propecia and saw thinning hairline.
 

Raccooner

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hairhelp777, could you direct me to some of these LLP forums you mentioned previously? To answer your question, I have the typical receded temples in the front.

This is another look of the area. It seems the shape changes when the hair is oily as opposed to washed or dry.
 

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DoctorHouse

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A qualified tric will use terms like follicular units, look for miniaturization ratio of telogen velus to terminal hairs with microscope. Kind of hard to come by unfortunately
Did you ever go to Shapiro Medical yet?
 

hairhelp777

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hairhelp777, could you direct me to some of these LLP forums you mentioned previously? To answer your question, I have the typical receded temples in the front.

This is another look of the area. It seems the shape changes when the hair is oily as opposed to washed or dry.
Typical LPP symptoms are itching/burning sensations that come and go. Do you have any loss at the front? Is it just the spot in the crown? Do you have itchiness? Do you have other photos you can post of the affected area- try not to cover it with the rest of your hair.
 

Raccooner

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I think my condition is more likely folliculitis decalvans based on pictures I'm seeing.
 
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