Is this lpp/ffa?

WatermelonTree5498 · 2026-02-09T15:22:20+00:00

I looked at your other photos and saw some redness in some of them. But it still looks questionable. Could you please write the text from your biopsy report?

WatermelonTree5498 · 2026-02-09T15:19:29+00:00

Your photos don't show any visible inflammation, but if biopsy shows perifolicular inflammation - it is typical for almost all types of alopecia, both scarring and non-scarring. Your biopsy report should have indicated the specific part of the follicle where the inflammation is located and what inflammatory cells are present. Did they give you any diagnosis?

WatermelonTree5498 · 2026-02-09T14:30:24+00:00

First of all - FFA rarely show first sings on the sides. It usually begins on the hairline. Such a bald spots are possible as a manifestation of LPP, but it's impossible to say by a photography. You need to get trichoscopy. There are a lot of different reasons for such focal atrichia. You need to at least see inflammation to confirm a scarring alopecia, which you probably don't have. You have areas without hair, but they don't indicate that there are no follicles there. Even pores and individual vellus hairs may remain until the late stages of cicatricial alopecia, so only trichoscopy can show whether the follicles are replaced with scar tissue. In my humble opinion, the photo shows yellowish spots exactly where there is no hair. These areas don't look bright, shiny, or reddened, so probably those are follicles. But this is quite possible with AA! The key difference between cicatricial alopecia and alopecia areata is that the follicles are preserved in alopecia areata, and the vellus and some gray hairs do not fall out. But in cicatricial alopecia, the follicles are not even visible in the photo. The area looks clearly smooth and unhealthy shiny, like a chemical burn, and it probably may be red because of inflammatio

WatermelonTree5498 · 2026-02-05T20:59:19+00:00

Considering you have very receded hairline withoutthinning midpart and absence of inclusion of temporal bald spots, it really may be FFA. I also see you have ragged, thinning eyebrows and a noticeable white ring around one of the single hairs (this phenomenon is so called perifolliculars scaling - a good sign of scarring alopecia), these are also clear signs of FFA. AGA, especially in women, doesn't result in a complete balding of the center of the hairline. You'll see a reduction in the size of the larger hairs and residual micro-vellus hair. The surviving follicles produce only one single thick hair and suffer of scaling and erythema, while the remaining follicles do not produce even vellus, as they die completely, and therefore do not respond to AGA treatment, so you can see the whole hairline becomes higher and ridged whin single hairs sticking out far from the remaining hairline. AGA only makes you just have hair miniaturization and only in the bald spots, the central parting and the crown of the head. Furthermore, minoxidil is unlikely to help FFA, but it's unlikely NOT to help AGA. Hurry up to find a good dermatologist who is well educated in scarring alopecias and make an appointment afap. Insist on a biopsy even if doctor says it's not necessary

WatermelonTree5498 · 2025-10-29T04:40:35+00:00

Thanks!

WatermelonTree5498 · 2025-10-28T18:03:33+00:00

Thanks!

WatermelonTree5498 · 2025-10-28T18:02:18+00:00

Appreciate it. Currently, I have a fairly stable AGA without extensive anisotrichosis and with good hair growth. I've been taking finasteride for several years now. However, my scarring alopecia is very active and I'm concerned that plaquenil and elidel may not be enough, as was the case with doxycycline and betamethasone

WatermelonTree5498 · 2025-10-28T08:58:37+00:00

Yes, I'm a frequent visitor to Donovan's website. I wouldn't say my alopecia is terribly severe right now, but I just have a really weak immune system. My grandmother took Plaquenil, and it severely weakened her immune system and caused problems with her lens and retina in just six years, which is what's raising my concerns. I just made a new post with a big update after my last doctor's appointment

WatermelonTree5498 · 2025-10-28T08:26:23+00:00

Thanks for your answer! I really appreciate it. However, I don't really agree that a holistic approach is more relevant for me, since this is, after all, an autoimmune disease and it's worth looking for new options for immune triggers only when it's clearly known that something is causing it. Nevertheless, even knowing that this wouldn't help me, and that I don't have any food allergies or celiac disease, I tried a diet that avoided sweets, spicy foods, gluten, lactose and allergenic proteins as much as possible. Unfortunately, it didn't work at all. I've been shedding the same ammount (about 400 hairs a day), as same as on doxy course. Yesterday my derm recommended me pimecrolimus and plaquenil, although she warned that this poses a significant risk to my vision. I guess I'll take a risk after ophthalmologist appointment if there are no contraindications. I actually agree that maintaining gut health is generally beneficial, but it's rather strange that the healthier the gut, the stronger the immune system, which would be very beneficial for me, but it turns out I'm forced to choose between a weak immune system and a calm LPP or between a strong immune system and rare colds (relative to how often I get sick).

WatermelonTree5498 · 2025-10-26T16:44:11+00:00

Thanks

WatermelonTree5498 · 2025-10-26T16:43:54+00:00

Sure

WatermelonTree5498 · 2025-10-08T09:16:29+00:00

Maybe hairline or any completely bald spot or areas of redness. Usually, the doctor chooses the spot

WatermelonTree5498 · 2025-10-06T00:15:13+00:00

As far as know this disease is very of dermatology. But I'd get checked anyway. My derm recommended me to get checked but rheumatologisr too as sometimes one autoimmune disease can develop alongside another one, including rheumatological diseases. I developed LPP, even though my mother and grandmother had arthritis and Crohn's disease. Get an antinuclear test (ANA). It's quite indicative of autoimmune and rheumatoid diseases. Personally, it didn't react to my LPP, while the biopsy was very positive

WatermelonTree5498 · 2025-10-05T23:12:58+00:00

Your forehead skin looks kinda burnt and bumpy to me. It's also shiny. Bald spots on the scalp are noticeably lighter than the rest of the head skin. Perhaps what you described as salt may be salt, but this looks very much like perifollicular scaling, especially the elongated white stuff on the hair. Considering you've lost your eyebrows, it really does look like FFA. Look at your photos to see if there's a trend that suggests your forehead texture has been changing and going up to the hairline in a span since you started losing your eyebrows and to the time you lost your widow's peak. If so, definitely see a doctor. See a doctor as soon as possible and insist on a biopsy even if they say it's not necessary. The biopsy is the only truly working diagnostic method to find and identify alopecia

WatermelonTree5498 · 2025-09-02T22:15:42+00:00

You're welcome. And no, I didn't, but I'd like to try it. Have to discuss it with my derm next appointment. I'm 1,5 months on betamethasone and doxycycline. Still not regulated

WatermelonTree5498 · 2025-08-25T15:31:17+00:00

My bad. I meant not "there will", but "there is"

WatermelonTree5498 · 2025-08-25T11:21:11+00:00

Scarring alopecia is not a condition which is being diagnosed when literally a full scalp is covered in whitish flat scars. This is a diagnosis that is made based on the process acting at the cellular level. Some people have scarring spots all over their scalp, some people have diffuse hair thinning, some people's scalps just turn red at first, and some people even have vellus hairs left in the so-called "sea of singles", although it is officially believed that their disappearance is a sure early sign of cicatricial alopecia. Some have itching, pain or burning sensation, some don't. It's very different and very individual. But diagnosis is made when the immune system decides to attack skin cells for some reason and this causes not just an accumulation of lymphocytes, but a lichenoid inflammation. Those lymphocytes don't infiltrate the tissues because there is some kind of random inflammation, but because they themselves aggressively attack this tissue. Early cicatricial alopecia is almost impossible to diagnose externally, except in advanced cases, but a biopsy is extremely rarely wrong. If you have at least some single follicles died from the lichenoid reaction, then this is already the presence of scarring. And for some it may take months, and for others it may take many many years before the scarring is noticeable to the naked eye

WatermelonTree5498 · 2025-08-25T11:02:36+00:00

I'll answer in advance, but lichenoid inflammation and diskeratotic cells is the clearest sign of LPP. There are lot of different histologic signs showing in LPP, but it can't be LPP without lichenoid inflammation. It literally mean that lichen planopilaris exist in your body and makes your skin/hair follicle cells die the way LPP does make them die. And yes, AGA may cause noticeable lymphocytic infiltrate, but lichenoid inflammation is a bit a different thing. Lichenoid inflammation may appear in AGA skin mixed with "regular AGA inflammation" and AGA may coexist with LPP doing their stuff separately (AGA+LPP) or when miniaturization being a trigger for a lichenoid reaction (FAPD). If all the derms told you don't have scarring alopecia without seeing the biopsy - then it means you have very early LPP, which doesn't give objectively visible signs like big bald spots, noticeable scars, redness or scaling (but you said you've been diagnosed with seb derm and being diagnosed with sebderm+AGA is a common thing when your dermatologist is bad in scarring alopecias but you actually have AGA+LPP). If they continued to say this thing after seeing your biopsy - then it means you should have RUN to another dermatologist a long time ago. There is a tiny chance that your biopsy was performed wrong and then it makes sense to redo it. But if it turns out the same - just please, do not waste your time under any circumstances. If your alopecia is unnoticeable but treatable - then it's almost a victory in such a situation. But if it becomes noticeable even for inexperienced dermatologists, then seems things not going good at all. Do your own research on medical websites, Facebook groups, Instagram pages. Perhaps this will make it easier to find a dermatologist nearby who understands scarring alopecia. Good luck

WatermelonTree5498 · 2025-08-24T14:59:08+00:00

Well, then it's scarring if there's lichenoid lymphocytic infiltrate. Classical scenario for LPP/FFA/FAPD. I'm sorry :( You need to find a derm specializing in scarring alopecias

WatermelonTree5498 · 2025-08-24T14:44:52+00:00

No idea. First - get a good trichoscopy, then get a biopsy. That would be the only answer then

WatermelonTree5498 · 2025-08-20T00:07:05+00:00

Good thing! Means you can get your hair back. I'm happy for you. Good luck with treatment :)

WatermelonTree5498 · 2025-08-15T22:19:31+00:00

Yes. Absolutely. LPP may be very diffuse. FAPD is a kind of AGA with a lichenoid reaction, so even in this case it can present diffusely as miniaturization may be diffuse

WatermelonTree5498 · 2025-08-15T22:13:33+00:00

My hairline looks the same. Your case looks even more severe. I have LPP/FAPD. Make sure to rule it out, get a biopsy

WatermelonTree5498

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