Author: Dr. William Rassman

Hi,

I recently went to a dermatologist to be diagnosed with AGA despite no family history (even 3 generations back). I am a 29 year old male, who has been overweight for a few years (~50-60 lbs)and generalized anxiety disorder. I was prescribed “Valium” and a beta blocker called “Propranolol” in December 2009. Sometime in 2011, my head began to itch, sometimes more, sometimes less. By February 2012, I noticed suddenly that there was a thinning patch on my crown and my scalp looked red and inflamed and itched more often.

The dermatologist also took two 4 mm punch biopsies from two sites on my vertex and pathology sent them back as AGA w/ active “Lichen Planopilaris”! I had never even heard of this before. My research just shows me it’s extremely rare, is incurable and for the most part will ruin my life unless I enjoy being bald. What am I supposed to do? Everyone else is calm about the situation, and my derm says he doesn’t yet “buy it” that it’s lichen due to my clinical presentation (Are transverse biopsies ever wrong?)

I’ve read you can’t even restore your hair with HT if Lichen is there because it will just destroy that hair too. How does this Lichen disease come about? I’ve read beta blockers can cause lichen planus, and i’ve been on a low dose for 4-5 years now. I’m not sure what to do, I don’t know why I’d have LPP or where it came into existence from. If its me reacting to the drug, would my hair restore itself if I came off of it after years?

Does LPP also cause miniaturization of hairs because that’s apparently happening as well. How statistically unlucky does one have to be to have both AGA with no famiily history + some rare LPP disease that will scar my head for life?

I’m lost and confused and so far no one has begun any treatments for anything. I know I can’t take propecia, and I know steroids won’t be tolerated well in my body if I have this lichen disease of unknown origin.

Have I received a death sentence for my scalp? The crown/vertex is thinning and a small thinning keeps developing down the parting of my hair. My hairline itself hasn’t receded at all since puberty… The top of my scalp is generally pink/reddish at all times with a little red itchy bump scattered sporadically around my whole scalp.

Thank you for reading my desperate post. I’ve gone from the extremely thick course hair I’ve had my entire life and model with, to losing what feels like 70% of it in the course of 15 months at age 28-29. It is imperative that I restore my hair to its previous glory. I do have pictures if you are interested.

Unfortunately, much of what you said is true. Transplanting hair into an area of active disease will kill the hair grafts. Most doctors will not do a surgery like a hair transplant where the odds are against the success of the procedure. I don’t know the specific statistics for those that have lichen planopilaris, as it is a rare scarring alopecia and difficult to treat.

There are some options: hair pieces, Scalp MicroPigmentation / SMP (which requires you to shave your head for best results), and topical concealers like Toppik.