Lichen Planopilaris Dormancy and Hair Transplantation: Caution! Caution! Caution!

Is my Lichen Planopilaris (LPP) Dormant? Can I have a transplant?

A common question I receive is a question from patients who want to know if there LPP is dormant or not - and whether they can proceed with a hair transplant. I generally need to see a patient up close to determine if their LPP is dormant or not. However, out of every 10 people who ask me if their LPP is dormant…I would estimate that 8 are not. Yes, the number is really that high. I consult with patients who have been given the green light to proceed with hair transplant surgery when they are not really good candidates. I consult with an equal number of patients who have undergone hair transpant surgery thinking their LPP was quiet only to experience poor growth or unfortunately even a flare of their disease. This flare sometimes leads to more hair loss than the patient had going into surgery.

Several years ago I published my own personal views on what constitutes being a good candidate for surgery. It has been used by many physicians around the world.

DONOVAN LPP HAIR TRANSPLANT CANDIDACY CRITERIA

So - is my LPP Inactive/Quiet/Dormant?

In order to increase the liklihood that a patient’s LPP is ‘inactive’ (and therefore increase the likelihood that they might actually be ready for consider surgery), the patient MUST answer ‘No” to these 4 questions:

1) Have you have ANY itching, burning or tenderness in the scalp in the last 2 years?

2) Have you been on ANY topical or oral medications for your LPP in the last 2 years?

3) Does your hair density look ANY different compared to 2 years ago?

4) Does the clinical examination by an experienced dermatologist who understands LPP show ANY evidence of disease activity during the last 2 years?

If a patient can really answer ‘no’ to these 4 questions, there is a good chance the LPP is dormant. It’s by no means a guarantee, but it increases the odds massively. My person feeling is LPP does not get the respect it so deserves. The recommendation that is too often given is that a little bit of this cream or a little bit of that lotion settles things right now and makes a patient ready for a transplant. It’s simply not accurate. That’s not how LPP behaves.

LPP is a disease to be respected. It does not have a timeline. It does not always become quiet although it is more likely to become quiet when treated with more aggressive medications and treatments (oral medications, steroids injections). LPP tells us when it is quiet but we need to do all the hard work and be patient to determine if it is or not. We need to take photos every few months. We need to follow the symptoms the patient has. We need to examine the scalp periodically. One can never ever determine LPP is quiet by meeting a patient one time. Never.

To say thatLPP can never be tranplanted is wrong but it’s a view held by some. To say LPP is ready to be transplanted after just a few months of dabbing some medications on the scalp is also wrong but it is also a view held by some. LPP requires a methodical approach to first suppressing and stopping the disease and then removing medications to see if the disease stays quiet over a prolonged period (ideally 2 years). Once the disease has been quiet and inactive and dormant for 2 years…. one can cautiously approach the possibility of a hair transplant.