Is this scar tissue from LPP or other type of hair loss or is it normal? (Photos)

Question

If it is scar tissue could it be from aga or something else? There are some photos from my scalp first one and second one I took recently and third is from 2 years ago. First and second are 8x zoom and 3rd is 3x I'm currently on min topical fin and dutasteride pills for 2 years and I'm 27, the pictures are from my both sides of my head above my ears.

Jeff Rapaport, MD · Answer

Your photos show Early Androgenetic Alopecia. No signs of LPP.
 **Decreased Hair Density**: There is a reduction in the number of terminal (thick and pigmented) hairs.
**Increased Vellus Hair**: A higher proportion of vellus (fine and short) hairs compared to terminal hairs, indicating miniaturization, a key feature of AGA.
**Altered Anagen/Telogen Ratio**: An increase in the percentage of hairs in the telogen (resting) phase and a decrease in the anagen (growth) phase. This change reflects the shortened growth phase typical of AGA.
**Decreased Hair Diameter**: The diameter of individual hairs decreases, further contributing to the appearance of thinning hair.
Additional Treatment Suggestions for you:
**Low-Level Laser Therapy (LLLT)**: This non-invasive treatment uses laser devices to stimulate hair follicles and promote hair growth. It's considered safe and can be used in conjunction with other treatments.
**Platelet-Rich Plasma (PRP) Therapy**: PRP involves injecting your own platelets (and exosomes) into the scalp to stimulate hair growth and improve hair density. It's considered an excellent treatment and may be used in conjunction with other therapies to provide better results. ( Combination Therapy)
Find a hair specialist for a comprehensive examination including extensive history, blood work and possibly Biopsy. 
Jeff Rapaport MD FAAD 
Realself Hall of Fame 
Castle Connolly Top Doctor

Anna Chacon, MD, FAAD · Answer

I can provide you with some general information that might help you understand your situation better.

Lichen Planopilaris (LPP) is a form of scarring alopecia that typically presents with symptoms such as itching, burning, and tenderness of the scalp, along with noticeable hair loss and scarring. The affected areas may show redness, scaling, and a decrease in the number of hair follicles.

Androgenetic Alopecia (AGA), on the other hand, is a common form of hair loss that typically does not involve scarring and is characterized by a gradual thinning of hair, primarily at the crown and frontal scalp in men, and a more diffuse thinning over the top of the scalp in women.

Here are a few points to consider:

1. **Scarring in LPP:** If the scalp shows signs of scarring (i.e., smooth, shiny areas where hair follicles seem to be absent), it might suggest LPP or another form of scarring alopecia. This can be confirmed by a dermatologist through a clinical examination and possibly a scalp biopsy.

2. **AGA Characteristics:** AGA usually does not cause scarring. The hair follicles remain present but produce thinner and shorter hairs over time. The use of medications like minoxidil (topical) and finasteride or dutasteride (oral) are common treatments for AGA.

3. **Treatment Response:** If you have been on minoxidil, finasteride, and dutasteride for two years, evaluating the progress or changes in your scalp condition is important. If there's an improvement or stabilization in hair loss, it might indicate effective management of AGA. However, if there's noticeable scarring or worsening despite treatment, further investigation might be warranted.

4. **Consultation with a Specialist:** Given the complexity of diagnosing hair loss conditions, it's crucial to consult with a dermatologist or a trichologist. They can perform a thorough examination, possibly including dermoscopy or a biopsy, to determine the exact cause of hair loss and the presence of any scarring.

5. **Differential Diagnosis:** Other conditions that can cause scarring alopecia include discoid lupus erythematosus, folliculitis decalvans, and frontal fibrosing alopecia, among others. A detailed clinical history and examination are essential for accurate diagnosis.

For a precise diagnosis and tailored advice, please schedule an appointment with a healthcare provider specializing in hair disorders. They can review your medical history, examine your scalp, and potentially perform diagnostic tests to provide a clear diagnosis and appropriate treatment plan.

Jeff Donovan, MD, PhD · Answer

What you are showing in these 3 photos is not typical of LPP scarring. So the answer is likely no. But it’s important for you to take not that we never diagnose hair loss from 1 or 2 photos. Not at all. Hair loss is diagnosed by listening to a patient’s entire story from birth up until today and examining every square inch of the scalp, eyebrows, eyelashes and nails. From what has been presented in this question, LPP is not likely. Trichoscopy of LPP shows perffollicular redness, perifollicular scale and or loss of ostia. Other features like acquired pili torti are often seen. Be sure to see an expert if concerns persist. A biopsy can help get you the answer if any doubt still exists.

Is this scar tissue from LPP or other type of hair loss or is it normal? (Photos)

Answers (3)

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