How would I know if Lichen Planopilaris has burned out without another biopsy?

A biopsy is not the way to go to determine if LPP is burned out. Of course that is frequently done- but that’s a big mistake. All that a biopsy tells you is the level of inflammation inside a 4 mm tube of skin. Even if there is inflammation it does not necessarily tell you that hair loss is occurring in that area. To tell whether LPP is burned out, one needs to first be off all medications for about 2 years. Then a clinician needs to confirm that there are no clinical signs if the disease including no redness, scaling or pustules. Second, the patient needs to confirm there is no itching, burning or pain. Finally, and most importantly of all one needs to compare a set of photos 2 years apart. This includes photos of the front, middle, top, sides, back, eyebrows and eyelashes and body hair? Do the photos look 100 % identical? In other words, does the density in the front now look 100 % the same as the density 2 years ago? If so, the chances are high things are burnt out? If there has been any loss, there is a good chance things are not burned out.