Some folks don’t respond to 5AR inhibitors and find no other option but to quit and embrace baldness instead of consider the immunologic possibility of their hairloss. Could Lichen Planus and related illnesses be, in combination or by themselves, be accountable for hairloss on a relevant scale? Why aren’t we discussing this topic more?

The diagnosis of lichen planopilaris is a cause of alopecia. The diagnosis can be made using a trichoscope by seeing perifollicular erythema, milky-red areas, classic white and blue-grey dots. This is an autoimmune disease that kills off the hair. It is more common in women than men, although the diagnosis is being picked up more so in some men lately. If a surgeon doesn’t make the diagnosis and does a hair transplant, the transplant will fail. A costly mistake. A biopsy usually is the final authority for the diagnosis.

This is an good result in a young man who appears to be responsive to these medications.

Good response from 5 months finasteride, minoxidil and microneedling

Two years of minoxidil foam 5% plus finasteride. You should have comparable photos but the difference is so dramatic, that the look alone says it all

There is clearly more hair in the photo on the right after the 3 month treatment.  He probably will regrow most of that hair within 8 months or so.

Androgenic alopecia does not cause consistent hair loss. It is an up and down problem with hair loss often rapid and then slow.

What determines who is a responder and who is not? Is it the amount of sulfotransferases in the scalp or something else? I always assumed those who don’t respond to the topical version will respond to the oral because the liver has more of these enzymes which will convert the minoxidil to minoxidil sulfate.

There are tests that can tell you if you will respond to topical minoxidil.  Minoxidil has to be converted to an active form by sulfotransferase enzymes that may or may not be present in sufficient quantities in hair roots. When the drug is taken orally, it is automatically converted to an active form so if it is taken orally, the response is much, much higher.