Hyperpigmented Upper Eyelid: A Clue to the Diagnosis of Facial Lichen Planus Pigmentosus in a Patient with Frontal Fibrosing Alopecia

Lichen Planopilaris (LPP) is an autoimmune condition causing permanent hair loss and fibrosis, often misdiagnosed. Treatments include pioglitazone, topical corticosteroids, anti-inflammatory medication, and Jak inhibitors.

A user has been experiencing hair loss for 4 years, with treatments like minoxidil, finasteride, and various supplements proving ineffective. They were diagnosed with fibrosing alopecia in a pattern distribution, a condition that may require a combination of anti-inflammatory and hair growth treatments.

Excess sebum rich in cholesterol and triglycerides can lead to hair loss through inflammation, with treatments like Ciclopirox shampoo, Benzoyl Peroxide shampoo, and Clindamycin gel recommended for managing conditions like seborrheic dermatitis and folliculitis. Pioglitazone is suggested for Lichen Planopilaris, while Omega-3s and reducing processed foods may improve sebum quality, though genetic factors play a significant role.

Topical pirfenidone is highlighted as an effective anti-inflammatory and anti-fibrotic treatment for hair loss, particularly in addressing perifollicular fibrosis, which may enhance the effectiveness of standard treatments like finasteride and minoxidil. The user also uses calcipotriol, MCT oil, ciclopirox shampoo, and benzoyl peroxide shampoo as part of their regimen.

The user is experiencing hair improvement in the central and back areas after using finasteride, minoxidil, and a galenic lotion, but the temple area is worsening. They suspect the lotion might be causing the issue and are considering stopping its use.

Topical melatonin shows promise for increasing hair density with minimal side effects. The user is transitioning from oral finasteride to a compounded minoxidil and finasteride solution and considering melatonin and bimatoprost as additional treatments.