Is it lpp or seborrheic dermatitis? (Photo)

Question

My scalp started to look like this 4 months after hair transplant and 3 month after using minoxidil its not all over my head, its itchy but its very mild its get better after using keto shampoo but it didn't go away completely i have this for almost 18 month or so and pull test is negative maybe 1 or 2 hair out of 70 80 hair strands, there are some pictures with different timelines

Anna Chacon, MD, FAAD · Answer

Thank you for sharing your history and photos. Based on your description—mild itchiness, partial improvement with ketoconazole (keto) shampoo, no significant hair loss, and a negative pull test—your symptoms are most consistent with seborrheic dermatitis rather than lichen planopilaris (LPP).

Seborrheic dermatitis often causes mild itching and flaky, sometimes greasy, scales on the scalp. It tends to improve with antifungal shampoos like ketoconazole, though it can be persistent and may require ongoing maintenance. LPP, on the other hand, usually causes more intense symptoms, including scarring, redness around hair follicles, and permanent hair loss, which you have not described.

Here’s what you can do:

Continue using ketoconazole shampoo as directed.
For flares, a short course of a low-potency topical steroid or a non-steroid anti-inflammatory cream (like a calcineurin inhibitor) can help reduce inflammation and itching.

Try to minimize scalp irritation from hair products or harsh treatments.
If the condition does not improve, worsens, or you notice new symptoms (such as increased hair loss or scarring), consider seeing a dermatologist for further evaluation. Sometimes, a scalp biopsy or trichoscopy is needed to rule out other conditions like LPP.

Overall, your symptoms and response to treatment are reassuring for seborrheic dermatitis, which is manageable with the right regimen.

Matt Tahsini, MD · Answer

Hello and thank you for your question.  It looks as though you have seborrheic dermatitis.  I suggest seeing your doctor in case you need antibiotics.  Best of luck to you.

Dr. T

Eeshara Vithana, MBBS, MSc, MD · Answer

This looks like seborrheic dermatitis Quite a common condition You might need cortisone lotion like EloconYou can have a script from you doctor In a worst case you have to be on 3 to 6 months of antibiotics like Doxycycline

Wipawan Vathananai, MD · Answer

I would recommend you to see a specialist regarding this issue. I could be aggravated seborrheic dermatitis or other types of alopecia.
However, since you said that hair pull test is still negative at the moment. Meanwhile, you can put topical steroid to relieve the itchiness. Topical steroid can treat both seborrheic dermatitis and LPP.
I hope this help!

Is it lpp or seborrheic dermatitis? (Photo)

Answers (4)

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