Dr Donovan, thanks for sharing your wealth of knowledge with us! I have had LPP for about 9 yrs, but was diagnosed in Sept. I immediately addressed diet, mainly cutting out processed foods. I haven’t had a big shedding in 9 yrs, but this hair loss is so subtle especially for ppl like me who had long thick hair to begin with. I am doing everything not to go on meds. If I can control my diet, stress and exercise, should I expect this to become dormant? Thanks again!
LPP can go to sleep on its own after some time. For extremely mild cases of LPP, there are a small proportion of patients who do report improvement of LPP activity with certain diets but good studies have not yet been done in this area. I'd estimate about 1 in 200 people with very mild LPP have the observation that their disease shuts off with these sorts of dietary and lifestyle changes. Dietary changes do not seem to help everyone but play a role. For a rare patient, it's the key step but for many with LPP it is probably is a helpful adjunct step. Rarely is it the only step that shuts off the disease. I haven't found dietary measures alone to consistently shut off the disease in those with more significant inflammatory forms. It's probably important to bring on board as a measure but whether to make it the only measure requires careful consideration and discussion with a physician who specializes in LPP
Thank you for your resources and knowledge. I was diagnosed with fibrosising alopecia in a pattern distribution in oct. 2021. If I manage the AGA element would that resolve the LPP since the inflammation is attacking the miniaturized follicles, or am I misunderstanding?
Great question and probably not. You are assuming the management of the AGA is 100.00% effective which it is not. So we need to manage the inflammation in most cases. Even in situations of the human body where the trigger is removed, we often need anti-inflammatory treatments for a while to remind the immune system to settle down. Management of AGA alone is usually not completely effective - although it sure does help.
Dr. Donovan, do you think it’s possible to have alopecia areata without peribulbar lymphocytic inflammatory infiltrate? I’m a 21f with severe hair loss in my hairline and temples. I had 2 scalp biopsies done at 2 different dermatology offices. Both came back non scarring with a differential diagnosis of alopecia areata, traction, androgenetic alopecia, TE. The biopsies showed a telogen count of 89%, miniaturization, fairly sparse perivascular and perifollicular predominately lymphocytic infiltrate, follicular stelae. My derm thinks it’s either AA or AGA but is leaning towards AA. I don’t have a history of tight hairstyles, I only wear my hair down. My bmi is 17.3 and all my blood tests are normal, no PCOS. I’m at a loss of what to do because It’s spreading rapidly on my temples. I’d love to know your thoughts. Thank you so much Dr.
Sure, it's possible to have AA without peribulbar inflammation but usually acute alopecia areata has this finding. Chronic alopecia areata and subacute forms of alopecia areata don't have the peribulbar changes. So it's possible to have alopecia areata without peribulbar changes. If the telogen count is truly 89% (and you did not mistype and actually mean to say the anagen percent), that's unusual and worth a review with an expert who can review your scalp up close and review your biopsy and blood tests with you with a fresh look. Telogen counts of 89% are not seen in androgenetic alopecia and traction and rarely even seen in telogen effluvium. They can be seen in alopecia areata and a few other states. Now, if you actually meant to write anagen percentage that's a different story as 89 % anagen hairs can be seen in all these conditions you mention. I can't say what diagnosis you have as I would need to see your scalp up close myself and review your story. That's the only way to make the diagnosis. You might find this article helpful as it outlines what physicians can do in challenging cases where the diagnosis is still open to debate: donovanmedical.com/hair-blog/what-to-do
@@donovanmedical9780 Thank you so much for your response Dr. Donovan! I just rechecked my biopsy results and it says 89% are telegon, and 11% are anagen. I’m going to pass this article along to my derm. I’ve been dealing with hair loss for over 2 1/2 years now so hopefully I’ll find out what’s going on soon. Thank you again!
I don't think there is any evidence this is a strategy that has benefit over any other oil. One needs to determine the cause of the build-up first and then figure out a treatment strategy. Any oil can loosen buildup and there is nothing special about magnesium oil. All oils loosen build-up to some degree but there are no studies with magnesium.
Very scientific and evidence based answers from an esteemed dermatologist
Dr Donovan, thanks for sharing your wealth of knowledge with us! I have had LPP for about 9 yrs, but was diagnosed in Sept. I immediately addressed diet, mainly cutting out processed foods. I haven’t had a big shedding in 9 yrs, but this hair loss is so subtle especially for ppl like me who had long thick hair to begin with. I am doing everything not to go on meds. If I can control my diet, stress and exercise, should I expect this to become dormant? Thanks again!
LPP can go to sleep on its own after some time. For extremely mild cases of LPP, there are a small proportion of patients who do report improvement of LPP activity with certain diets but good studies have not yet been done in this area. I'd estimate about 1 in 200 people with very mild LPP have the observation that their disease shuts off with these sorts of dietary and lifestyle changes. Dietary changes do not seem to help everyone but play a role. For a rare patient, it's the key step but for many with LPP it is probably is a helpful adjunct step. Rarely is it the only step that shuts off the disease. I haven't found dietary measures alone to consistently shut off the disease in those with more significant inflammatory forms. It's probably important to bring on board as a measure but whether to make it the only measure requires careful consideration and discussion with a physician who specializes in LPP
Hi Dr, have you ever had any male AGA dutasteride non responders? If so have you put any on high dose dutasteride e.g. 2mg daily?
What’s the treatment of PPB hair loss ?
Thank you for your resources and knowledge. I was diagnosed with fibrosising alopecia in a pattern distribution in oct. 2021. If I manage the AGA element would that resolve the LPP since the inflammation is attacking the miniaturized follicles, or am I misunderstanding?
Great question and probably not. You are assuming the management of the AGA is 100.00% effective which it is not. So we need to manage the inflammation in most cases. Even in situations of the human body where the trigger is removed, we often need anti-inflammatory treatments for a while to remind the immune system to settle down. Management of AGA alone is usually not completely effective - although it sure does help.
Dr. Donovan, do you think it’s possible to have alopecia areata without peribulbar lymphocytic inflammatory infiltrate? I’m a 21f with severe hair loss in my hairline and temples. I had 2 scalp biopsies done at 2 different dermatology offices. Both came back non scarring with a differential diagnosis of alopecia areata, traction, androgenetic alopecia, TE. The biopsies showed a telogen count of 89%, miniaturization, fairly sparse perivascular and perifollicular predominately lymphocytic infiltrate, follicular stelae. My derm thinks it’s either AA or AGA but is leaning towards AA. I don’t have a history of tight hairstyles, I only wear my hair down. My bmi is 17.3 and all my blood tests are normal, no PCOS. I’m at a loss of what to do because It’s spreading rapidly on my temples. I’d love to know your thoughts. Thank you so much Dr.
Sure, it's possible to have AA without peribulbar inflammation but usually acute alopecia areata has this finding. Chronic alopecia areata and subacute forms of alopecia areata don't have the peribulbar changes. So it's possible to have alopecia areata without peribulbar changes. If the telogen count is truly 89% (and you did not mistype and actually mean to say the anagen percent), that's unusual and worth a review with an expert who can review your scalp up close and review your biopsy and blood tests with you with a fresh look. Telogen counts of 89% are not seen in androgenetic alopecia and traction and rarely even seen in telogen effluvium. They can be seen in alopecia areata and a few other states. Now, if you actually meant to write anagen percentage that's a different story as 89 % anagen hairs can be seen in all these conditions you mention. I can't say what diagnosis you have as I would need to see your scalp up close myself and review your story. That's the only way to make the diagnosis. You might find this article helpful as it outlines what physicians can do in challenging cases where the diagnosis is still open to debate: donovanmedical.com/hair-blog/what-to-do
@@donovanmedical9780 Thank you so much for your response Dr. Donovan! I just rechecked my biopsy results and it says 89% are telegon, and 11% are anagen. I’m going to pass this article along to my derm. I’ve been dealing with hair loss for over 2 1/2 years now so hopefully I’ll find out what’s going on soon. Thank you again!
What do you think about putting Magnesium oil on your scalp for buildup?
I don't think there is any evidence this is a strategy that has benefit over any other oil. One needs to determine the cause of the build-up first and then figure out a treatment strategy. Any oil can loosen buildup and there is nothing special about magnesium oil. All oils loosen build-up to some degree but there are no studies with magnesium.