Today I want to discuss a patient who recently presented to me for a consultation for his hair loss. He stated that he had been gradually losing his hair over the past 10-15 years and now it had reached a point where all the hair in the frontal and mid scalp had fallen out. He was seeking a hair transplant.
Most of the cases of male hair loss I see in my practice are typical genetic hair loss which responds amazingly well to the hair transplant procedure. In this case, a close examination of the scalp revealed that the skin in the frontal and mid scalp was completely smooth and devoid of sweat glands that you normally see in healthy skin, including balding regions of the scalp. In addition the hair follicles on the periphery of the balding regions showed tiny red dots of inflammation surrounding them and they were easy to pull out. The patient also showed hair loss on his sideburns and eyebrows. I suspected a scarring form of alopecia and referred the patient to a dermatologist for a scalp biopsy and confirmation of my diagnosis.
On biopsy the diagnosis of Lichen Ploanopilaris was confirmed. This is an inflammatory scarring alopecia of the scalp that presents clinically in this exact manner. The biopsy also showed that the LPP appeared to be inactive. The patient came back to me and I explained that we could do a very small hair transplant procedure of test grafts in 3-4 different locations of the scalp to see if the transplanted grafts grew well. If they grew well, we could then proceed to a larger procedure to create some degree of cosmetic density in the areas of hair loss. I also explained to the patient that even if the transplanted hair grew well, there was still a chance that the LPP could reactivate in the future and destroy the transplanted grafts.
The patient decided to move forward with the hair transplant test grafts and we should know in 3-4 months if the growth is successful. I will continue to update you on the progress of this interesting case.
All the best,
Marc Dauer, M.D.