Author: Dr. William Rassman

I have been diagnosed with Pityriasis lichenoides chronica which I have had since I was 15. About the same time my hair started thinning. I am now in my mid 30s and I have general thinning (no hairline recession) from the crown to the front. Both sides and the back of my head is fully thick. I have started propecia and minoxidil.

Is there any connection between the PLC and my hair loss?

I have no personal experience with pityriasis lichenoides chronica (PLC), but as I understand it, there’s not much known about the condition. How it relates to hair loss is unclear. For those readers that are curious, PLC “is characterised by the gradual development of symptomless, small, scaling papules that spontaneously flatten and regress over a period of weeks” (source: DermNet NZ).

What I do know is that the most common cause of hair loss in men is genetic male pattern baldness (MPB). It occurs in a pattern from crown to front as you describe, leaving the hair on the sides and back “fully thick”, as you also describe. It could be possible that you have PLC along with MPB and the two are unrelated.

It seems you need a good diagnosis and you cannot get that here on the Internet. You need to find a physician who can examine you and give you his assessment. A miniaturization study may be helpful as well and may point to the association of genetic male patterned hair loss if that is also present.

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I have been losing hair since I was about 17 (I am now 23), and I’m confused as my hair loss seems to have characteristics of both DUPA and typical MPB.

For example, I have a receding hairline and a small bald spot at the vertex – typical of MPB. However, I also have general thinning on the crown, forelock and down the sides and back of my head. Is it possible to have a receding hairline with DUPA? I was under the impression men with this kind of hair loss retained their hairlines.

If you have the gene for male pattern baldness (MPB), the expression of the gene will dictate when the hair loss starts and which balding pattern that you will evolve into. In most people, the frontal loss starts at the leading edge of the frontal hairline, but a few people will keep their frontal hairline while they lose the hair behind it. When it comes to those with diffuse unpatterned alopecia (DUPA), the loss of the hairline as you describe is possible.

Here’s an excerpt from a paper published in 1997 referring to DUPA that may clarify: Diffuse Unpatterned Alopecia patients have a similar progression of balding as the DPA [diffuse patterned alopecia] patient except that the progression is often more rapid and will more likely eventuate in a “horseshoe pattern” resembling the Norwood class VII, except that in contrast to the Norwood VII, the DUPA “horseshoe” can look almost “transparent” due to the low density.

The hair on the sides and in the back of the head (a 3 inch high part of the scalp that starts at the body prominence of the skull aka the “horseshoe pattern” mentioned above) is looked at as permanent hair in most men. In the diagnosis of DUPA, this permanent zone has miniaturized hair in excess of 20%. The higher the miniaturized hair count in the permanent zone, the more difficult it will be to get enough good healthy donor hair for a hair transplant.

Women have what looks like DUPA in that same area and also often throughout the head. This makes most affected balding women poor candidates for hair transplantation.