I had biopsies performed due to diffuse hair loss. I noticed the density decreasing with mild recession of my hairline. Biopsies both performed at the frontal area. One returned as “compatible with early LPP” and the other as “AGA without LPP” LPP microscopic description “Mild perifollicular inflammatory infiltrate of lymphocytes and histiocytes surrounding infundibla of follicles with slight concentric perifollicular mucinous fibroplasia”. Can this possibly not be LPP?
December 9, 2024
Answer: Can this possibly not be LPP? Sure, there is a small chance it’s not. There are subtle hints at a diagnosis of LPP but yes it’s incomplete and there is a chance you don’t have (there is also a chance you have). You need to take really special note as to how we reach a diagnosis of somebody’s hair loss. it’s NOT by staring at a biopsy report over and over. That’s where mistakes happen. We reach a diagnosis of hair loss by reviewing THREE things all AT THE SAME TIME. This includes 1) the entirety of the patient’s story of hair loss and their general health and 2) what exactly things look like on trichoscopy and 3). The findings of the biopsy. We need all three. You have given me one of the three things that are needed so of course there is no way of saying what is really and truly going on in your case. And even with this biopsy I would not even begin to say I have all the biopsy information I need. You’re going to want to speak to your doctors and ask for a more complete pathology report (if your doctor feels it’s needed). You see, in a situation like this, I also need to know 1) are sebaceous glands lost or not??? 2) is their any evidence of follicular keratinocyte necrosis or lichenoid changes?? 3) are elastic fibers altered on VVG special stains??? Your biopsy report does not have all the information that is really needed in a challenging situation like this!!. one should never be too fooled into thinking perifollicular inflammation and perifollicular fibrosis equates to LPP. No! Those can be features of AGA in some cases. All in all, one needs to remember that we don’t diagnose hair loss solely by staring a biopsy reports. The clinical and examination findings TOGETHER with a good and complete biopsy report is what is needed. Be sure to speak to your doctor and interpreting dermatopathologist about these issues.
Helpful 1 person found this helpful
December 9, 2024
Answer: Can this possibly not be LPP? Sure, there is a small chance it’s not. There are subtle hints at a diagnosis of LPP but yes it’s incomplete and there is a chance you don’t have (there is also a chance you have). You need to take really special note as to how we reach a diagnosis of somebody’s hair loss. it’s NOT by staring at a biopsy report over and over. That’s where mistakes happen. We reach a diagnosis of hair loss by reviewing THREE things all AT THE SAME TIME. This includes 1) the entirety of the patient’s story of hair loss and their general health and 2) what exactly things look like on trichoscopy and 3). The findings of the biopsy. We need all three. You have given me one of the three things that are needed so of course there is no way of saying what is really and truly going on in your case. And even with this biopsy I would not even begin to say I have all the biopsy information I need. You’re going to want to speak to your doctors and ask for a more complete pathology report (if your doctor feels it’s needed). You see, in a situation like this, I also need to know 1) are sebaceous glands lost or not??? 2) is their any evidence of follicular keratinocyte necrosis or lichenoid changes?? 3) are elastic fibers altered on VVG special stains??? Your biopsy report does not have all the information that is really needed in a challenging situation like this!!. one should never be too fooled into thinking perifollicular inflammation and perifollicular fibrosis equates to LPP. No! Those can be features of AGA in some cases. All in all, one needs to remember that we don’t diagnose hair loss solely by staring a biopsy reports. The clinical and examination findings TOGETHER with a good and complete biopsy report is what is needed. Be sure to speak to your doctor and interpreting dermatopathologist about these issues.
Helpful 1 person found this helpful
