How does hair recover from lpp and is it possible to differ lpp scars from other types of scars with a biopsy? (photos)

Lichen planopilaris (LPP) is an inflammatory condition that affects the scalp and can lead to permanent hair loss due to scarring. To address your concerns:

Hair Recovery from LPP
1. **Medical Treatment**: The primary goal in treating LPP is to halt the progression of the disease. Treatments may include:
- **Topical corticosteroids** or intralesional steroid injections to reduce inflammation.
- **Oral medications** such as hydroxychloroquine, doxycycline, or immunosuppressants.
- **Light therapy** (phototherapy) in some cases.

2. **Hair Regrowth**: If LPP is caught early and treated effectively, some hair regrowth might occur, especially if the hair follicles are not completely destroyed. However, in areas where scarring has occurred, hair regrowth is typically not possible.

Differentiating LPP Scars from Other Types of Scars
A scalp biopsy can be instrumental in differentiating LPP scars from other types of scarring. Here’s how it works:
- **Histopathological Examination**: A biopsy will show specific features characteristic of LPP, such as:
- Lymphocytic infiltration around the hair follicles.
- Interface dermatitis (inflammation at the junction of the dermis and epidermis).
- Follicular hyperkeratosis and perifollicular fibrosis.

These features can help distinguish LPP from other scarring conditions or from scars due to trauma (like those from hair transplant harvesting).
Biopsy Site Selection
Choosing the biopsy site is crucial, especially given your history of hair transplant and existing scars:
- **Active Areas**: Ideally, the biopsy should be taken from an area that shows active disease (redness, scaling, or hair loss) rather than from scarred areas.
- **Avoiding Harvest Sites**: Since your donor area has scars from harvesting, it might be best to avoid these areas for the biopsy. Instead, select a site that shows signs of active disease but is not heavily scarred from the transplant.
- **Consultation with Dermatologist**: A dermatologist specializing in hair disorders can help determine the best site for the biopsy to ensure accurate diagnosis.

Possibility of Hair Thickening
If you have LPP and it is treated effectively:
- **Stabilization**: The primary aim is to stabilize the condition to prevent further hair loss.
- **Regrowth**: In areas where hair follicles are not completely destroyed, hair may grow back thicker and stronger once the inflammation is controlled.
- **Permanent Loss**: In areas where scarring has occurred, hair regrowth is unlikely, and the hair transplant might need to be considered again if the disease is well controlled.

A scalp biopsy is essential in your case to confirm a diagnosis of LPP and differentiate it from other types of scarring. The biopsy should be taken from an area showing active disease, and a dermatologist can guide you on the best site. With appropriate treatment, it’s possible to halt the progression of LPP and potentially see some improvement in hair thickness in non-scarred areas.