I know this is a touchy subject, but have you noticed any correlation between MRNA vaccination and flare ups of LPP? Of course this is totally unrelated to the importance of vaccination. Thank you Dr.
PRP or platelet rich plasma is an option for CCCA but in my opinion it's a second line agent not a first line agent. Steroid injections, topical steroids and oral agents like doxycycline and growth stimulators like minoxidil should be considered first in my opinion. Second line agents like PRP and topical metformin can be considered in the future for a given patient depending on the response to first line agent and any contraindications. You can see the first, second and third line agents for treating CCCA here: donovanmedical.com/hair-blog/scarring-alopecia-tmt
Hi Dr Donovan, Do you have FFA cases that nothing worked for them? My derm put me on Dutasteride,Isotretinoin,Cyclosporine, Plaquenil and 10mg Prednisone. I’m losing hope as I see my hair disappearing. She said next step is Pioglitazone and Xeljanz. How long it takes Cyclosporine to work in FFA? Its been 5 weeks and no change 😢 Hope so much you’ll see my message🙏🏻🙏🏻🙏🏻
I don't have many FFA cases that truly nothing worked. We do have patients on 10 or more medications. For example: hydroxychloroquine, steroid injections, topical steroids, topical tacrolimus, topic tofacitinib, dutasteride, isotretinoin, cetirizine, fragrance free shampoos. Not everyone of course and not all these might be used daily. The medications you mentioned are backed by evidence too.
@@donovanmedical9780 Thank you for repyling🙏🏻Does Tofacitinib backed by research for FFA? I saw online only case reports for LPP using Tofacitinib. What do you think about Otezla? I’ve read what you wrote on your website and it sounds you’re very skeptical of this drug for LPP. There is someone on LPP facebook group who grown almost all of her hair back using Otezla. There is also Adalimumab which can cause regrowth in FFA according to CARF newspetter. If you need to choose between Tofacitinb,Adalimumab or Otezla what would you choose(based on efficacy only)?🙏🏻🙏🏻
@@E10l I think you've misinterpreted. Otezla has limited evidence in the medical literature for LPP. That's the point. I use in my clinic from time to time so I'm not so skeptical. The key point is there is little medical studies that are published to date. For FFA, tofacitinib would have much more evidence as of Feb 2022 for FFA.
@@donovanmedical9780 Ok, I got it. My derm wants me to start Tofacitinib in a month. She already sent the paperwork for insurance. Meanwhile she wants to give Cyclosporine last chance to see if its working(taking it already for 2 months). My derm said I’m the worst case she has ever seen in all of her long career. I feel like I’m a walking clinical trial. I’m receiving also Isotretinoin,Dutasteride,Plaquenil,prednisone, Clexane 3mg subcutaneously once a week(its shown to help Lichen Planus). Its fun to be a rare autoimmune disease 😔
@@E10l Thanks for sharing. I would need to know more about your specfiic story but in some cases that are highly refractory, we pull out all stops as the expression goes. Hypoallergenic shampoos, patch testing if appropriate, gluten and dairy free diets and rich rich veggie diets. This of course in addition to the evidence based immunomodulatory treatments. Other triggers of the immune system need to be explored (other medications, implants, devices, exposures). thanks for sharing and hope you get things under control.
Great video.!!.....question: Can scarring alopecia be diffuse and all over the head mimicing Chronic Telogen Effluvium with a truncated anagen cycle??? Particularly if the scarring alopecia came from damage to the scalp from doses of Topical Tretinoin that caused inflammation and/ or Topical Triamcinolone at a does too high that caused burning? My mair fell out by the roots and only stopped when I took and Oral Steroid taper. It could have been a coincidence because it was around the 3 month mark, but my scalp was VERY inflammed before the steroid.
Scarring alopecia (ie lichen planopilaris) can be diffuse. Yes. That part of the question is easy. But it's very unlikely that the description above is a story of scarring alopecia like lichen planopilaris. LPP would not usually come to an end so quickly. The good news is that it's easy to confirm or refute a diagnosis of LPP with one or two simple 4 mm punch biopsies. Loss of sebaceous glands with evidence of follicular damage (necrosis/lichenoid change) would be supportive of that diagnosis. Overall, it's very very unlikely that the scenario presented above represents a diagnosis of LPP. However, a full clinical history together with a good scalp examination and biopsy read by a skilled dermatopathologist can rule out or rule in scarring alopecia. The story here is more liklely to be one of a highly responsive dermatitis rather than a folliculocentric immune based scarring alopecia. Be sure to see a dermatologist for full review and consideration of biopsy.
@@dbrown1500 That would be a very typical story of someone who shed. Depending on how long it's been since the episode, non-scarring hair loss conditions such as 1) telogen effluvium or 2) telogen effluvium precipitating androgenetic alopecia need to be properly considered. A hair specialist help you can confirm what's actually going on with the steps above. For the first 2-6 months after a shed we expect hairs of different lengths. That's normal. However, in a 'true' telogen effluvium without evidence of coexistent androgenetic alopecia, that scalp returns back to normal in 6-12 months. After 1 year, this variation in the length of hairs is no longer appreciated.
Hi Dr. Donovan, Is confocal microscopy able to determine if a scarring alopecia is active or burnt out or is a scalp biopsy necessary to differentiate this? Thank you for all the precise knowledge you share regarding hair loss! Greetings, Jeffrey
Confocal microscopy can not. However, one should not assume that a biopsy is what is always needed to get this information. A really good history and good physical examination (with trichoscopy) gets us this information in 99% of cases.
none that we confidently known yet. No published study in the last 20 years has shown that a homeopathic medication can burn out LPP. I suspect that many probably have benefit.
Hello Dr. Donovan, My son is 17 years old and developed alopecia since 2018. Recently he went through 2 biopsies which concluded Lichen Planopilaris. However his dermatologist does not agree with the report as there is no sign of inflammation so there is no treatment for him other than viviscal and anacaps supplements with Neoptide lotion. His dermatologist cannot prescribe him anything as e is unsure of which alopecia he has. His Dht levels are also very high. 4760.can you please advise? He never has itchy or burning feeling. Please help.
Thank you Dr Donovan......great, informative video.....
thanks so much
Thank you for your video. I have learned some things.
great ! thanks Sam
I know this is a touchy subject, but have you noticed any correlation between MRNA vaccination and flare ups of LPP? Of course this is totally unrelated to the importance of vaccination. Thank you Dr.
yes, I most certainly have. Fortunately, it's not too common
Thank you. Great information!
thanks very much
Have you utilized Plasma treatment? I think its P2P. Is that an option for CCCA that is not burnt out?
PRP or platelet rich plasma is an option for CCCA but in my opinion it's a second line agent not a first line agent. Steroid injections, topical steroids and oral agents like doxycycline and growth stimulators like minoxidil should be considered first in my opinion. Second line agents like PRP and topical metformin can be considered in the future for a given patient depending on the response to first line agent and any contraindications. You can see the first, second and third line agents for treating CCCA here: donovanmedical.com/hair-blog/scarring-alopecia-tmt
Hi Dr Donovan, Do you have FFA cases that nothing worked for them? My derm put me on Dutasteride,Isotretinoin,Cyclosporine, Plaquenil and 10mg Prednisone. I’m losing hope as I see my hair disappearing. She said next step is Pioglitazone and Xeljanz. How long it takes Cyclosporine to work in FFA? Its been 5 weeks and no change 😢 Hope so much you’ll see my message🙏🏻🙏🏻🙏🏻
I don't have many FFA cases that truly nothing worked. We do have patients on 10 or more medications. For example: hydroxychloroquine, steroid injections, topical steroids, topical tacrolimus, topic tofacitinib, dutasteride, isotretinoin, cetirizine, fragrance free shampoos. Not everyone of course and not all these might be used daily. The medications you mentioned are backed by evidence too.
@@donovanmedical9780 Thank you for repyling🙏🏻Does Tofacitinib backed by research for FFA? I saw online only case reports for LPP using Tofacitinib. What do you think about Otezla? I’ve read what you wrote on your website and it sounds you’re very skeptical of this drug for LPP. There is someone on LPP facebook group who grown almost all of her hair back using Otezla. There is also Adalimumab which can cause regrowth in FFA according to CARF newspetter. If you need to choose between Tofacitinb,Adalimumab or Otezla what would you choose(based on efficacy only)?🙏🏻🙏🏻
@@E10l I think you've misinterpreted. Otezla has limited evidence in the medical literature for LPP. That's the point. I use in my clinic from time to time so I'm not so skeptical. The key point is there is little medical studies that are published to date. For FFA, tofacitinib would have much more evidence as of Feb 2022 for FFA.
@@donovanmedical9780 Ok, I got it. My derm wants me to start Tofacitinib in a month. She already sent the paperwork for insurance. Meanwhile she wants to give Cyclosporine last chance to see if its working(taking it already for 2 months). My derm said I’m the worst case she has ever seen in all of her long career. I feel like I’m a walking clinical trial. I’m receiving also Isotretinoin,Dutasteride,Plaquenil,prednisone, Clexane 3mg subcutaneously once a week(its shown to help Lichen Planus). Its fun to be a rare autoimmune disease 😔
@@E10l Thanks for sharing. I would need to know more about your specfiic story but in some cases that are highly refractory, we pull out all stops as the expression goes. Hypoallergenic shampoos, patch testing if appropriate, gluten and dairy free diets and rich rich veggie diets. This of course in addition to the evidence based immunomodulatory treatments. Other triggers of the immune system need to be explored (other medications, implants, devices, exposures). thanks for sharing and hope you get things under control.
Great video.!!.....question: Can scarring alopecia be diffuse and all over the head mimicing Chronic Telogen Effluvium with a truncated anagen cycle??? Particularly if the scarring alopecia came from damage to the scalp from doses of Topical Tretinoin that caused inflammation and/ or Topical Triamcinolone at a does too high that caused burning? My mair fell out by the roots and only stopped when I took and Oral Steroid taper. It could have been a coincidence because it was around the 3 month mark, but my scalp was VERY inflammed before the steroid.
Scarring alopecia (ie lichen planopilaris) can be diffuse. Yes. That part of the question is easy. But it's very unlikely that the description above is a story of scarring alopecia like lichen planopilaris. LPP would not usually come to an end so quickly. The good news is that it's easy to confirm or refute a diagnosis of LPP with one or two simple 4 mm punch biopsies. Loss of sebaceous glands with evidence of follicular damage (necrosis/lichenoid change) would be supportive of that diagnosis. Overall, it's very very unlikely that the scenario presented above represents a diagnosis of LPP. However, a full clinical history together with a good scalp examination and biopsy read by a skilled dermatopathologist can rule out or rule in scarring alopecia. The story here is more liklely to be one of a highly responsive dermatitis rather than a folliculocentric immune based scarring alopecia. Be sure to see a dermatologist for full review and consideration of biopsy.
@@donovanmedical9780 thank you so much!
@@donovanmedical9780 also fun fact! 85% of the hairs that shed were the long hairs and left me with many different hairs of different lengths.....
@@dbrown1500 That would be a very typical story of someone who shed. Depending on how long it's been since the episode, non-scarring hair loss conditions such as 1) telogen effluvium or 2) telogen effluvium precipitating androgenetic alopecia need to be properly considered. A hair specialist help you can confirm what's actually going on with the steps above. For the first 2-6 months after a shed we expect hairs of different lengths. That's normal. However, in a 'true' telogen effluvium without evidence of coexistent androgenetic alopecia, that scalp returns back to normal in 6-12 months. After 1 year, this variation in the length of hairs is no longer appreciated.
Hi Dr. Donovan, Is confocal microscopy able to determine if a scarring alopecia is active or burnt out or is a scalp biopsy necessary to differentiate this? Thank you for all the precise knowledge you share regarding hair loss! Greetings, Jeffrey
Confocal microscopy can not. However, one should not assume that a biopsy is what is always needed to get this information. A really good history and good physical examination (with trichoscopy) gets us this information in 99% of cases.
Homeopath treatment can burnout lpp?
none that we confidently known yet. No published study in the last 20 years has shown that a homeopathic medication can burn out LPP. I suspect that many probably have benefit.
Hello Dr. Donovan,
My son is 17 years old and developed alopecia since 2018. Recently he went through
2 biopsies which concluded Lichen Planopilaris. However his dermatologist does not agree with the report as there is no sign of inflammation so there is no treatment for him other than viviscal and anacaps supplements with Neoptide lotion. His dermatologist cannot prescribe him anything as e is unsure of which alopecia he has. His Dht levels are also very high. 4760.can you please advise?
He never has itchy or burning feeling. Please help.
I'd be happy to help. Please contact my office so we can arrange a time to speak or meet.
Dear Dr. Donovan,
Thank you very much. We have submitted application for our son. Hope to see you soon.